Advanced Beneficiary Notice Case Study

4. describe actions to take where any concerns with the agreed care plan are noted

Any situation that erupts which can disturb the other residents is something that must be diffused immediately, as a healthcare administrator I would have to address this state of affairs with empathy and genuine concern for the opinions of the family members not in agreement with the do not resuscitate (DNR) order. First, I would ask that we move to a private location where we could speak and if voices are elevated it would not interfere with the day to day operation of the nursing home. Second, I would ask to see the Power of Attorney if it is available to speak to the legality of the document. Provided that, all the previous terms set in place are up to par, I would directly talk about the statement made about the family member making me aware of her position with the Department of Health and Human Services. Moreover, going through the document to point out the date signed, to make note if the new resident signed it before here memory was too far gone and if the Power of Attorney would not be substantial. Then I’d call attention to the difference between a Power of Attorney and Durable Power of Attorney. Grammarly states, “The biggest difference is in when the power ends. A general power of attorney ends when a person becomes mentally incapable because of sickness or injury to handle his or her own affairs… To get a durable power of attorney, you must show in the

Many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status then the care should be provided and is covered by Medicare.In fact, patients often receive an array of treatments that don 't need to be carried out by a skilled nurse but that may, in combination, require skilled supervision.Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will

Documentation and communication are constant challenges that healthcare providers face when seeking continuity of care for their patients. Every time a patient moves from a hospital to a nursing home, or from a skilled nursing facility to home health or hospice, the staff that cares for the patient is at risk for a gap in patient care and communication. Home health and hospice agencies rely heavily on Medicaid and other insurance for reimbursements in order to continue to provide care for their patients and keep the doors to their agencies open. Thorough and timely documentation is the key to ensuring proper reimbursement for nursing services and other therapies provided from insurance agencies. This same

The Federal Patient Self-Determination Act (PSDA) of 1991 first brought attention to the importance of advance directives (GAPNA, n.d.). Although regulatory bodies continue to promote advance directives, little has been done to encourage and enforce this initiative, highlighting the need for directed efforts to improve AD completion rates. The overall prevalence of completed advance directives in the United has been estimated that 5-15% (Tung & North, 2009). This indicates a need for programs to educate and empower patients and providers to ensure that dialogue about advanced care planning is initiated early on, and that advance directives are completed. Studies have shown that patients prefer that their primary care doctor initiate such planning while they are in good health and that such planning should occur earlier than it did in terms of age, natural history of disease, and patient-physician relationship. The barriers to advance care planning that have been identified include availability of trained staff, organizational commitment and policy to support advance care planning, and understanding/support of providers (Ramsaroop, Reid, & Adelman, 2007).

A designated office within the state agency is responsible for coordinating, scheduling, and facilitating appeals for Medicaid beneficiaries. All appeals are heard by an impartial hearing officer employed by or on contract with the Agency. The designated office handles the appeals process from receipt of the request from a beneficiary/client through the final administrative decision. During the hearing process, the designated office is responsible for ensuring that the use or disclosure of beneficiary information is in compliance with federal law (HIPAA), state law and Division of Medicaid policies, and procedures regarding the safeguarding of beneficiary information.

There was no revenue. Like it is listed above after auditing the remittance advice logs and medical records, the Revenue Cycle Team has determined that medical necessity is not being met for code 93798 (Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]) and around $20,790.00 was written off due to ABN’s (Advance Beneficiary Notice) not being issued. b. How would you suggest rectifying this issue?

Therefore, reimbursement to APRNs is limited for the many services that are provided to patients (Yee, Boukus, Cross & Samuel, 2013). In Florida, legislative sessions are held at specific dates throughout the year. According to the Florida Association of Nurse Practitioners (FLANP), three specific bills of interest that affect ARNP scope of practice: “SB 96 is proposed in to allow ARNPs to be medical directors; S634/HB 645 will enable ARNPs to sign Certificates of Involuntary Commitment (Baker Act) and CS HB129 will declare all Floridian ARNPs to be medical directors and gain signature ability and HB 7011 which initiates independent full practice for NPs” (Florida Association of Nurse Practitioners (FLANP), 2017).

The afore= mentioned issues being addressed through legal channels by the AANP are barriers to effective and efficient practice, the type of barriers that were to be eliminated by the expansion of the Affordable Care Act (ACA) (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Only twenty-two states have allowed full practice authority, which is less than half of the nation. It is imperative that every advance practice nurse has a voice that is heard in their state and the nation, this is the message of the AANP (Hain & Fleck,

“The majority of the states do not require the principal to notify the person appointed as the health care agent or surrogate when establishing the document. However, several states, including Alabama, Michigan, Oregon, and North Dakota require that the attorney-in-fact accept their

What do you think about this request? On my opinion we shouldn't place the claim on hold b/c we don't know for sure if Medicare will go back date it her coverage.If we place the claim on hold the patient don't go to receive the statement and we don't know if the patient will be continue to f/u her issue with her insurance. What do you think?

The federal law that would be waived by the specific waiver on which the ACO (accountable care organization) and its participants intend to rely is “The Beneficiary Inducements CMP Law” and the waiver is the Waiver for Patient Incentives. This law prohibits offering or giving something of value to Medicare or Medicaid patients that would influence their choice of provider (from text book pg-184). The ACO’s formed in connection to the Shared Savings program, helps beneficiaries to obtain incentives offered to encourage preventive care and comply with the treatment regime. In the absence of the patient incentive waiver, the ACO is influencing the beneficiaries to accept the services from a specific provider thus, violating the Beneficiary Inducements CMP Law.

The adult-gerontology acute care nurse practitioner (AGACNP) has many responsibilities. In addition to providing excellent patient care, the AGACNP must also know how to code for patient services, bill appropriately and know how much they should expect in reimbursement for specific treatments. Many legal issues arise for the AGACNP, including several forms of negligence; the AGACNP should be educated on the essential elements. Finally, the AGACNP must educate themselves and be prudent to avoid legal issues related to malpractice. In the following paragraphs, each of these issues will be discussed.

It is important that you make sure you report, any changes that you see immediately to your manager or senior so if need be they can be recessed and that any new changes have also been added to the individuals care plan. If need be if appropriate mentioned to the family.

Mrs. Darden elected COBRA benefits as she was in need of keeping her insurance after she stopped working. Mrs. Darden applied for assistance through the American Kidney Fund as she knew the importance of keeping the insurance that was being offered. The American Kidney Fund has been assisting Mrs. Darden with payments since October 2016. Mrs. Darden’s premiums were sent by the American Kidney Fund on 3/23/17 and this check was never cashed. Unfortunately Mrs. Darden was not notified her premiums were not received. On May 22nd , 2017 another check for Mrs. Darden’s premiums