Understanding Health Insurance: A Guide to Billing and Reimbursement (MindTap Course List)
14th Edition
ISBN: 9781337554220
Author: Michelle A. Green
Publisher: Cengage Learning
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True or false: Nursing care is considered an institutional service.
When a patient is being admitted from home,
the social worker should arrange for the medical records on the patient's last
hospitalization.
the facility should begin recording the patient's past history and background.
prior medical records are generally not available.
the social worker should obtain medical records from the admitting physician's
office.
To process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial.
Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim.
Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim.
From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing?
Please be sure to validate your opinions and ideas with citations and references in APA format.
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- How does health Insurance Portability and Accountability Act (HIPAA) facilitate electronic transactions? A Gives providers access to a centralized patient database B Gives covered providers unique identifiers to use with coding system C Allows anyone with computer access to file claims D Generates paper reports as a back up systemarrow_forwardWith the HIPAA laws, much emphasis has been placed on the patient’s privacy rights and the requirements of the health care organization (a covered entity) to ensure privacy of protected health information: When there is a breach of privacy, has a breach of fiduciary duty occurred? Discuss please. Thanksarrow_forwardThe Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. How can a physician get around the Physician Self-Referral Law?arrow_forward
- The LPN/LVN is preparing to take a verbal medication order over the telephone from a health-care provider. For which reason would this action be permitted by the LPN/LVN? The RN is going home with a sudden fever and vomiting. The order is in response to the emergency need for a patient. The LPN/LVN is the only person at the nursing station. The action is supported by both state board and facility policy.arrow_forwardThe purpose of obtaining a health history in today's medical office is to: a. have a basis for all treatment given by the provider and a guide for all future treatment. b. have information for the patient's personal use. c. have something to document in the patient's medical record. O d. have information for the insurance company.arrow_forwardWhat is typically needed to establish breach of a duty of care? Show answer choices A Causing direct physical harm to a patient (B) Violating a written policy Intending to commit malpractice D Failing to meet the relevant standard of carearrow_forward
- Discuss the importance of advocacy as it pertains to patient care. What is the nurse's role in patient advocacy? Describe a situation in which you were involved with patient advocacy. Explain what the advocacy accomplished for the patient, and what the repercussions would have been if the patient would not have had an advocate.arrow_forwardIn the late 20th century, many methods were used to pay physicians for services rendered. The most popular methods include all the following except payment as a base salary. according to a schedule of fee-for-service (FFS). based on usual, customary, reasonable (UCR) charges. based on resource based relative values(RBRVs). based on patient outcomes.arrow_forwardA hospital infromation system is accessed by the Receptionist ; when a certain patient arrives to the hospital the Receptionist must register his information , thin schedule an appointment if the doctor advise the patient to be admitted to the hospital for certain procedure or operation the Receptionist shall shedule an admission to the patient , ALL admitted patients must be a registered patients ,Furthermore the receotionist should be able to file insurance forms as well as keep the medical reports . identify the Actor(s) from the above scenario ?arrow_forward
- When asked the difference between a health maintenance organization (HMO) and a preferred provider organization (PPO) plan, what would be the correct response? A patient with a PPO plan will have no additional costs for services. An HMO provides better access to outpatient services and drug benefits. The two plans are essentially the same. A patient may choose any physician with an HMO plan.arrow_forwardThe term ABUSE as it relates to elderly people can include: (select all that apply): stealing money and assets from them □g causing them physical or emotional harm social or sexual abuse neglecting to care for them, such as not providing adequate food or withholding medications all of the above Signs of financial abuses as it relates to elderly people can include: (but is not limited response): missing belongings of the older person promise of good care in exchange for transferring property unfamiliar or new signatures on cheques and documents misuse of legal power such as power of attorney, enduring power all of the abovearrow_forwardThe advocacy role calls for the social worker's close involvement in coordination of appropriate services responsibility for total care enforcement of patient rights different types of conflictsarrow_forward
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