Chapter 1, Problem 1.25.1C

With the use of Electronic Health Records most healthcare facilities and offices no longer submit a paper claim form instead of the fields in the EHR translate in the background to an electronic format of the CMS 1500 (physician claim) or a UB04 (hospital claim) form. However, it is still essential that you understand how to complete a claim form properly. In reviewing the different Blocks on the CMS 1500 form, choose a section of Blocks (as discussed in the unit) and in your own words: List the Block Numbers (i.e., Blocks 1-8), Describe what information goes into the Blocks Discuss any formatting requirements for the Blocks and what happens to a claim if the formatting is incorrect. In the second document above, CMS discusses Incomplete or Invalid Submissions. Explain how the Part A/Part B Medicare Administrative Contractors (MAC) handles these types of claims. CMS also discusses the difference between a “clean claim” and “other-than-clean claims.” Explain in your own words the…

The RN and an unlicensed assistive personnel (UAP) are caring for a group of clients on a medical unit. Which information provided by the UAP warrants immediate intervention by the RN?  The client diagnosed with cancer of the lung has a small amount of blood in the sputum collection cup. The client diagnosed with chronic emphysema is sitting on the side of the bed and leaning over the bedside table. The client receiving a biologic response modifier, has a temp of 99.2 F, P 68, R 24 and a B/P of 198/102. The client receiving prednisone is complaining of an upset stomach after eating breakfast.

The 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?