Week 4 IHMO Assignment Davina Hall Medical Basics and the Healthcare Claims Cycle Ms. Blair UMA Three reasons a claim can be returned by the carriers could be Incomplete, Invalid or Rejected. Incomplete claims are claims that are missing required information. Any Medicare claim missing necessary information; such claims are identified to the provider so they may be resubmitted. A claim may be sent back because it is rejected; when claims need investigation and answers to some questions. A rejected claim is also an insurance claim submitted to an insurance carrier that is discarded by the system because of a technical error (omission or erroneous information) or because it does not follow Medicare instructions.
One evening, Kelly went to the movie theatre. When the movie was over, Kelly needed to use the restroom. As she emerged from the bathroom stall and approached the sink, Kelly slipped on a puddle of water in front of the sink, crashed to the floor and landed painfully on her shoulder. Earlier in the day, the movie theatre knew the bathroom sink pipe had broken and called a plumber to come fix it. The plumber called the theatre late in the afternoon and said she could not arrive until the next day.
Keep records out of view Don’t leave the sign in sheet out Do not gossip 6. A breach of confidentiality can result in what consequences for a health care professional? Disciplinary action or even a lawsuit. 7. From the list of Interpersonal Ethics (found in Chapter 1 of the Fremgen text), please describe how any of those traits were demonstrated in your actions in this case scenario?
However, it does not specify when to recognize or how to measure the items that make up comprehensive income. In reporting comprehensive income, companies are required to use a gross disclosure technique for classifications related to items of other comprehensive income other than minimum pension liability adjustments. For those classifications, reclassification adjustments must be disclosed separate from other changes in the balances of those items so that the total change is disclosed as two amounts.
Courts held that mere assertion of one’s illness or of matters unclear at times are insufficient to establish incompetency. Id. at 916. In Armour v. Peek, the evidence presented that grantor occasionally forgot relatives or where he parked his car, was not sufficient evidence to disprove competency and that mere assertion of one’s illness, or of matters unclear at times are insufficient to establish incompetency. Armour, 517 S.E.2d 527 at
Blood test confirmed no biological attachment, therefore, Fiege is not obligated to care for the alleged daughter. Reason: 1. Forbearance to sue for a lawful claim or demand is sufficient consideration for a promise to pay for the forbearance if the party of the forbearing had an honest intention to prosecute litigation which is not frivolous, vexatious, or unlawful, and which believed to be well founded. Boehm filed her claim with the honest intention to recover the monies which was promised to her if she forbear from filing a bastardy claim against Fiege. The formation of a contract created by both parties was legitimate showing no proof of fraud, deception, or
Also (except IPA members) doctors cannot participate in other plans. Provided services and drug costs are limited which can prevent physicians to make important decisions regarding patient’s care. In compare to indemnity plan HMO providers are at risk to receive lower revenue because of the capitation. Positive is low copayments and covered preventive care to patients (Raffel, Barsukiewicz, & Raffel, 2002). POS plan members choose primary doctors from the list and referrals to see specialist are required, however there is no deductible and copayments are low.
They did not identify and manage risks relating to health and safety of the patient. They did not take reasonable steps to identify the possibility of abuse and to prevent it before it occurred. They failed in their responsibilities to provide appropriate training and supervision to staff. They did not operate an effective recruitment procedure. They id not respond appropriately to allegations of abuse.
Common laws provide a resolution for courts if the similar case is presented in the future, making sure they have the same outcome. An example of a common law case is Flagiello v. Pennsylvania Hospital, 208 A.2d 193 (Pa1965). In this case, Flagiello was a patient that sued a hospital in Pennsylvania because she hurt herself on hospital property. The hospital said the injury was not related to the original purpose of admission. Her case was dismissed because the common law stated that hospitals, which are charitable institutions, could not be sued for negligence.
The body of the victim was found with pills in hand and on the table in front of her, a laptop open with an apparent suicide note on screen. The victim’s home was in disarray when she was found which tends to be a sign of a struggle. With that being said, there were no markings on the victim’s body that leads me to believe that there was a struggle. Although the victim’s sister claims she was a neat freak, which doesn’t rule out the thought of a struggle. The neighbor claims that he saw the victim’s boyfriend speeding out of her driveway two days prior to her body being discovered.