Identify at least one internal process breakdown each from the front-end, middle, and back-end workflows that could lead to a healthcare insurance claim denial.
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Identify at least one internal process breakdown each from the front-end, middle, and back-end workflows that could lead to a healthcare insurance claim denial.
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- 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?Who would be impacted by such events claims production and claims submission in healthcare?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.
- The Inpatient Payment System is used by Medicare to pay hospitals for services at a pre-determined rate for each discharge. Professional Administrative C) Prospective DiagnosticScenario: You are the MOA in a busy family practice. The following calls come in to your office. For each situation, respond in the most appropriate manner. How would you handle each call? If it is for your physician, do you put the call through? Do you take a message? Can you handle the call yourself? Provide a brief explanation for each example. “Hi, this is Mary Sutherland, I have an appointment on Friday afternoon to see the doctor, but I am not going to be able to make the appointment.”When time is used as a key component in billing an E/M service, the provider must document face-to-face time with the patient and how much time was spent counseling the patient with the family.
- As a risk manager, what are some issues that could occur or you could foresee happening due to a surgical procedure done under anesthesia?Do you think NANDA-I, NOC & NIC are applicable to Nursing Documentation (conventional written or electronic) here in the Philippine Setting? Why or why not? If it needs improvements or changes to be more effective and applicable to Nursing Documentation, what would it be?Nursing Homes Assistant Identify the most common form of litigation in Nursing Homes. Describe a situation in which an individual in this profession might be held liable for negligence and ways to proactively avoid or prevent negligence in the profession that you selected.
- Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting, and analysis of medical error that often leads to adverse effects. Question options: A) True B) FalseDefine and describe the term Tort Laws and include 4 key elements. Define and describe the term Medical Malpractice – give an example of the cost of malpractice insurance. Discuss how economic damages in medical malpractice settlements can affect healthcare. Based on what you have learned, are you for or against medical tort reform? Give at least 2 reasons for your decision along with 2 ethical issues that affect this topic. Back up your decision with examples, evidence and sources.What is the impact of the Anti-Kickback Statute on healthcare reimbursement and referrals
