Dr. Reilly has a patient, Jessica Adams, who needs to have a cystoscopy. Jessica knows a family friend who has received a cystoscopy in the past. Knowing that her friend has had multiple, surgeries, she has assumed that a cystoscopy involves surgery. Jessica believes that she understands the medical term cystoscopy even though she hasn’t set up an appointment with her clinician. Without having a full understanding of the procedure Jessica has made her assumption.
A second coding and billing error is typos. Typos could be incorrect dates of service or more operating time than was actually done. These typos can be found on the bill the person receives and if there are discrepancies in the bill, they need to be taken care of, usually by writing a letter to the medical facility or talking with the patient representative. The person should get a detailed bill so he or she is able to look over it well for typos or other errors. A third common coding and billing error is billing for non-covered services or billing over-limit services.
There are some legitimate reasons for breaching a patient’s confidence but there can be some considerable consequences as well. This paper will use the article by Pamela Nelson entitled “BIOETHICS ON NBC'S ER: Betraying Trust or Providing Good Care? When is it okay to break confidentiality?” as an example of an ethical dilemma involving patient confidentiality. Luckily for today’s healthcare workers we have several ethical frameworks to guide us and we can ask for the assistance of an ethics committee when we are faced with an ethical dilemma that involves patient confidentiality. Why is Patient Confidentiality Important?
My practice placement is with the district nurses based in a busy surgery in a suburban area. I discovered that one of the nurses had an interest in continence management, and that part of her remit was to try to avoid unnecessary catheterisations. It was explained to me that this was achieved by the use of the bladder ultrasound scanner for diagnostic purposes- in other words to see exactly how much urine was in the patients bladder. It was also explained that the only other alternative to this technique was to actually catheterise the patient to assess the post voidal urine measurement. It now appeared to me that this clinical skill would be useful to use for this module essay as it encompasses many of the core themes- for example, communication, record keeping, clinical decision making and professional judgement.
Pros and Cons of Managed Care PROs | CONs | Managed care is a set of techniques designed to make the providers of health care more accountable for the quality of the health care they delivered. | Premiums for private health insurance are getting costly. | Often negotiate lower rates for basic healthcare procedures with physicians, labs and various types of healthcare facilities. | Members may not be fully satisfied with the care that is given by a primary care physician and would want to consult with another who is not included in the network. | Many health insurance plans operate with the use of a wide range of physicians and specialists who are connected with the insurance provider network.
Vitals, symptoms, diagnosis, prescription, and post care are all significant information that must be noted to ensure that the patient’s insurance company know what they are paying the doctor for. This information is documented in a form of codes that are transported to the insurance company for payment. It is important to make sure that the proper code are recorded to avoid confusion on both ends. Inaccurately coding can lead to false claims which can eventually result in non-payment from the insurance companies. To ensure there are no errors, remaining organized and up to date on coding information is expected.
The brochure also states that even if they do not have insurance they the facility will try to help by finding financial help or by making other arrangements. Texas Good Samaritan Law The Texas Good Samaritan Law actually protects the person who administers emergency care or an individual unless the person to administer the care is found to have willfully given negligent care. In the case of Sandra this would have played a huge role simply because the consent to treatment was implied and the doctor made the decision to actually perform treatment even though Sandra was incoherent. The doctor actually made an informed decision based on the severity of the wound and in good faith proceeded with treatment to save her life. (Thornhill, Sherri) Respect, Empathy,
Advance Directives What kinds of medical care would you want if you were too ill or hurt to make that decision for yourself? Well there is a way to express your concerns about your medical care when you reach that point in your life when you are unable to make those decisions. You can create an Advance Directive. Advanced Directives allows you to give directions about your decision regarding your future medical care. Advanced Directives can protect your rights if you ever become unable to communicate your wishes due to an illness or injury.
This is an important aspect for physicians to understand because medical misconduct may prove to be detrimental to their career. Identifying the civil complaint process for patients or consumers used in the event of suspected professional misconduct or incompetence provides a clear understanding of how the consumer files a complaint of a physician. Explaining the role of the respective regulatory agency in investigation of allegations, determining, and applying any appropriate disciplinary action present an explanation of how misconducts are held accountable in the health care industry. Identification of potential criminal liabilities for physicians related to abuses perpetrated in practices involving these issues as well as misconduct emphasize why physicians must treat patients adequately in the proper manner. The appropriate risk management strategies and quality assurance programs that offer in reducing the risk of liability and negligence are of value to many organizations.
This would ensure that the account has a clean A/R at the time of the medical billing process. They would in addition, study claims rejected by carriers, low fees from the carriers, and clearing house rejections. Calling and compilation are other services which we incorporate into our AR collections solutions. If the patient is responsible for any payment including deductibles, we will make the necessary calls to the patient to collect the amount following