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

1. Is the profitability or loss of the typical nursing facility in the hands of Medicare and Medicaid system administrators? No, there’s no profitability or loss of the typical nursing facility in the hands of medicare and medicaid system administrators because medicare helps with medical costs for some people with

BACKGROUND OF PROBLEM 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

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.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org. This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not

On Tuesday July 7, 2015, at approximately 3:01 PM, Kiana Beekman, (MFCU Investigator) (Beekman) received a call on the state office telephone from HILL, Lucy (Service Facilitator of Lucy Hill Services (LHS). During the conversation, Beekman asked HILL to clarify her role and responsibilities as a service facilitator, in addition to the role and responsibilities of HARRIS, LaFrance as the Employer of Records (EOR) for Medicaid Recipient DANIEL, Rose and MCGHEE, Inocencia as DANIEL’s aide. She was also asked to provide any documentation of training on timesheet submission and approvals that she provided HARRIS and MCGHEE under the Department of Medicaid Services (DMAS) Consumer-Directed care aide program.

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).

• Support of NP’s ability to certify Home Health orders for patients under their care • Support of NP’s ability to order therapeutic shoes for diabetic 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

Oregon’s Death With Dignity Act has been in place for over twenty years. This legislation is a great basis for Michigan’s physician-assisted suicide legislation. There are a few points in their legislation that should be changed to further benefit Michigan. The following is written based on Oregon’s law (Death With

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?

1. 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.

Patient self- Determination Act (PSDA) encourages people to make a decision about the extent of medical care they want to accept or refuse (American Cancer Society, 2015). It is the responsibility of ethics committee to make patients aware of their rights. Also, “committee members need to be educational and advisory in nature, they should educate themselves, other health care workers, patients and the family members regarding the ethical principles and organization’s policy relating to the ethical issues”(Alexander & Kavaler, 2014). Many people are not aware with the advance directives, they don’t know how to complete advance directives (ADs), what are the state regulation to complete ADs and only a few people discuss their preferences with doctor, which do not protect their autonomy during the time of end- of- life (House & Lach, 2014). Health care professionals must be competent to provide information on ADs so that patients will be able to make a decision. In addition, patient’s wishes and ADs need to be discussed among family members and the health care providers so ethics committee plays an integral role in protecting patients’ preferences and supporting ADs process for

Business and Legal Considerations for the AGACNP Reimbursement Issues 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.