Evaluating The Validity Of Patients ' Claims Of Denial Of Services

When you need medical advice or treatment, we put a huge amount of trust in medical professionals. However, medical experts with serious consequences can make mistakes.

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

Medical malpractice lawsuits are an extremely serious topic and have affected numerous patients, doctors, and hospitals across the country. Medical malpractice is defined as “improper, unskilled or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional” (Medical malpractice, n.d.). If a doctor acts negligent and causes harm to a patient, malpractice lawsuits arise. Negligence is the concept of the liability concerning claims of medical malpractice, making this type of litigation part of tort law. Tort law provides that one person may litigate negligence to recover damages for personal injury. Negligence laws are designed to deter careless behavior and also to

Health information is an important source of information and evidence when the services provided are communicated in legal and professional documentation. It is a documentation which is a legal requirement and a record of the beneficiary’ care as well as a communication vehicle between other disciplines and providers. It not only ensures the services provided to individuals but is a crucial tool to support reimbursement of services and a basis for research. Incomplete and improper documentation potentially may lead into a denial of payment for services as well as question’s the quality of care provided.

Reducing the incidence of medical error by improving the accuracy and clarity of medical records.

Patient’s fifth right is for respect and care without discrimination from all members in the healthcare field. The right to confidentiality and privacy of their health information is sixth on the bill of rights and addresses their right to read, copy and request corrections to their medical record, to talk privately their medical providers and be assured their healthcare information is secure. The seventh right is for patients to have a “fair, fast, and objective review of any health care complaints” (Consumer Bill of Rights and Responsibilities, 1998). And finally our eighth right as patients are our responsibilities we have as the consumer of healthcare services. Patients need to comply with the orders of the medical provider so they can get and stay well. As a patient you must treat other patients and healthcare workers with respect, pay your medical bills in a timely manner, and abide by your selected healthcare plans coverage. As patients become more involved in the total healthcare process they increase the success of their treatment while assisting in lowering associated costs without a reduction in the quality of the healthcare they receive.

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

These plaintiffs (patients) desire admission to the defendant hospitals for the treatment of their illness, and to be treated by their present physician or dentist, without discrimination on the basis of race.

Improve the accuracy of patient identification. The recommendation is for all healthcare providers to institute a policy of using at least two patient identifiers when providing care, treatment, and services. This goal has two objectives, one to verify the individual as the person for whom the service or treatment for and to match the service or treatment to that individual.

In order to state a constitutional claim under the Eighth Amendment for lack of proper medical care, a prisoner must meet a three-fold test. First, the actions or inactions of prison authorities must correspond to a "deliberate indifference" standard. Estelle v. Gamble, 429 U.S. 97 (1976). Secondly, that deliberate indifference must be directed "to [a] serious medical need [ ]". Id. In order to state an Eight Amendment claim for denial of medical care, a plaintiff must demonstrate that the actions of the defendants or their failure to act amounted to deliberate indifference to a serious medical need. Id. at 106. Additionally, there must be some personal involvement on the part of prison officials. West v. Atkins, 815 F.2d 993 (4th Cir. 1987), rev 'd. on other grounds, 487 U.S. 42, 106 S.Ct. 2250 (1988). “Deliberate indifference to a serious medical need requires proof that, objectively, the prisoner plaintiff was suffering from a serious medical need and that, subjectively, the prison staff were aware of the need for medical attention but failed to either provide it or ensure the needed care was available.” Blackwell v. Webb, et al., Civil Action No. RDB-13-1947, at 10.

“Doctor Facilitated Denial: A Barrier to End-of-life Planning Among COPD Patients” conducted by Lauren Seidman, examined the correlation between the number of severe COPD patients who decide to pursue advanced care planning, and certain motivations behind this decision such as denial (facilitated or refuted by doctors), self-perceived health, and the patient’s trust in the advice of the physician. Seidman utilized data previously collected through decision aids such as the web program InformedTogether, as well as conducted her own research based on recorded medical meetings and surveys from a small, non diversified sample at North Shore Long Island Jewish Pulmonary Clinics. Also, theoretical bases such as the Integrative Model of Behavior Prediction,

In 2003, The Joint Commission made one of their first goals to improve the accuracy of identifying patients to reduce or eliminate patient identification errors. This continues to be an accreditation requirement. Their recommendations to do this are to use at least two patient identifiers when administering medications, and when providing treatments or procedures. Acceptable identifiers may be the individual’s name, an assigned identification number, telephone number, or other person-specific identifier. Patient room number or physical location may not be used as an appropriate identifier. Healthcare provides should re-identify the patient with each encounter, each medication pass, and each procedure. There have been procedures and protocols throughout the country have been put into place to make the care provided to patients safer. Another element of this requirement is that all containers should be labeled in the patients presences after using the patient identifiers

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly, or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can lead to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of the patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Many people do not ponder on the possibility of some form of malpractice or misdiagnosis occurring during their time as patient. They put their trust solely in the healthcare provider. More importantly nurses hardly ever consider being the one that causes harm or the one whom neglects a patient, let alone misdiagnose a patient. When entering the nursing field one needs to look at all options that will help protect them from sustaining any loss. Many nurses in today’s time are purchasing profession liability insurance or more commonly known as professional indemnity. Professional indemnity helps pay for expenses that occur during malpractice, negligence, and misdiagnosis lawsuits.

3. The Claimant’s amount of the sequence of events relating to the treatment in question. Care should be taken to avoid importing text and phraseology from medical records or reports that the Claimant would not use in the normal course of discussing the case.