Poem Review And Claim Analysis

Lorna Dee Cervantes' poem, “Poema para los Californios Muertos” (“Poem for the Dead Californios”), is a commentary on what happened to the original inhabitants of California when California was still Mexico, and an address to the speaker's dead ancestors. Utilizing a unique dynamic, consistently alternating between Spanish and English, Cervantes accurately represents the fear, hatred, and humility experienced by the “Californios” through rhythm, arrangement, tone, and most importantly, through use of language.

The lifecycle of physician-based claim (CMS 1500) is something that we not only need to know, but also how to do from start to finish.

This letter is in response to your first level Administrative Appeal filed with Horizon Behavioral Health on November 3, 2016. In this appeal, you requested reconsideration of the payment in the amount of $3632.16 on the claim for dates of service October 1, 2016 through October 4, 2016. You stated that the member was involuntarily admitted through the Emergency Department, therefore the claim should be covered at the full charge of $9137.40.

Member stating she was discharged home from Hanover Health and Rehab on 03/14/2017 with home health services in place. Member stating she had requested Encompass Home Health Agency but Bon Secours Home Health came out on 03/18/2017 and she stated she told Nurse she did not want that Agency. CM placed a call to Hanover Health and Rehab and spoke with Discharge Planner and she stated that Encompass could not take the case because of a shortage of staff. Member stated she would agree to have Bon Secours Home Health. Discharge Planner stated she would send the referral back to Bon Secours Home Health. Member stating she had post hospital follow up with PCP yesterday with no new changes. Member stating she reported the pain she is having to PCP

Telephone contact made to the patient. Two patient verifier used to confirm name and DOB. Patient states that she continue to have severe lower back pain that worsen with movement and standing for greater than 30 mins. Currently, patient rates her pain 5/10 resting, with an occasional pinching feeling in the lower back. Patient states that she is very concern because she needs her husband help for almost everything such has help with ADL, household chores. Patient states that her husband is due to deploy in January 9. Patient states she is schedule for her MRI January 5. Patient is requesting that her MRI be done asap. Patient states that she is taking her medications as prescribed but she continue to be in pain. Acute Apt was schedule for

The carrier has denied coverage of Equitest (computerized dynamic posturography) performed on 10/12/2015 as experimental and/or investigational and not medically necessary. There is a letter from the carrier to the member’s husband Ronald Williams, dated 02/18/2016, which states in part:

Pa's informal support is providing assistance during non-aide hours. Pa also continues to receive ERS from Medscope, which he uses in the event of an emergency. SC will continue to see Pa based on the agreed upon contact plan of home visits every three months, calls every month and annual reassessments. Base on the H.V. Pa is requesting stair ride a service increase to ensure his health and safety. Pa had reported 3 falls in the last three months and complained about the difficulty climbing stairs unsteady gait, severe pain, SOB, and generalized weakness. Nevertheless Pa's is satisfied his services. SC reviewed backup plan with Pa and Missy, and Stepdaughter (Natalya) or spouse Missy, will assist if PAS is not available. Pa denied any changes to backup plan this time and Pa denied having to use backup plan. SC provided and reviewed the "Who do I contact if. . ." form with Pa. There is no duplication of services. Waiver continues to be the payer of last resort. Pa remains NFCE Waiver appropriate. Note documented on 1/12/16 8:53-9:08

The Young Elites by Marie Lu contains the five main elements of a plot line. To start off, the song “What a Catch, Donnie” by Fall Out Boy is an excellent way to summarize the exposition. The lyrics explain “I got troubled thoughts/ and the self esteem to match”, which corresponds with Adelina’s life. Adelina is full of dark thoughts, and her dad is constantly mean to her, trying to provoke her. She is a Malfetto, a survivor of the plague. All Malfetto have a mark. Adelina has a terrible scar down her face, reminding her she is different. The lines “You’ll never catch us/ So just let me be” show Adelina just wants her father to leave her alone. She thinks if he would stop being mean to her, then her dark thoughts would also stop.

SC completed M T/C with Pa on 5/9/16. Pa reported that he went to the ER at Wiles Eye on 4/28/2016. He was treated by a Retina specialist and d/c the same day. The Pa stated that he woke up one day and had and couldn’t see. The Pa has a follow up appt on the 5/24/2016 with retina eye specialist at wiles eye. No hospitalization, recent falls, change in health status or medications were reported by the Pa. SC reviewed Pa's care plan and he reported that he is receiving services as outlined in the care plan. He remains satisfied with the services and feels that they meet his current needs. Pa is not requesting any change to the service plan at this time. Pa denied any other changes to her ADLs/IADLs, mobility, cognitive, social, emotional, environmental, or financial

Upon receipt of this referral, I contacted the claims adjuster Julie Rawlins to discuss the case. I researched Detroit Receiving Hospital for contact information. I contacted Detroit Receiving Hospital and obtained Mr. Davis’s location and I was informed 4 Q. I was transferred to the floor and spoke with the staff. I inquired if Mr. Davis was responsive and able to speak. I was informed he was not and was on a ventilator. I inquired if the family was at the bedside and I was informed no family had been seen. I inquired about the name and number to the case manager/discharge planner assigned to Mr. Davis. I was provided with Sandra Deboro pager number 5997. I contacted the main hospital again and spoke with the Harper Hospital Operator

Patient is a 38-year-old who presents to CRU from UPC. She is on ACOT for non-compliant with her COT plan. Per amendment letter, patient has been missing her home medication appointment and her mental health court. CBI is her OP treatment agency. Upon admission, patient stated her clinic has been giving out false information. Per collateral, she was at her clinic on Monday, 7/17/17 and got her Risperdal Consta 50mg IM. Her vitals are WNLs. She will benefit from meeting provider, and medication

Teri, I still have not received a response from either you or Meggie. I cannot stress how important this is to resolve this issue asap. We have over half a million dollars that are owed to us and we want some action. But, more importantly, as I am sure that you are aware this issue is affecting some of your Medicare Advantage patients; as they reside in areas that have limited access to hospice providers and because PruittHealth’ s inability to get authorization from UHC due to incorrect provider load, they are having issues seeking medical care.

I need your assistance. We have a patient Wilfredo Santiago, that was admitted into PruittHealth Lanier on 8/16. This patient used 26 days of benefit with Golden Living and was admitted into Northside hospital (amputation), and from there to PH Lanier for the remaining four days of benefits.

Poetry is a reduced dialect that communicates complex emotions. To comprehend the numerous implications of a ballad, perusers must analyze its words and expressing from the points of view of beat, sound, pictures, clear importance, and suggested meaning. Perusers then need to sort out reactions to the verse into a consistent, point-by-point clarification. Poetry utilizes structures and traditions to propose differential translation to words, or to summon emotive reactions. Gadgets, for example, sound similarity, similar sounding word usage, likeness in sound and cadence are at times used to accomplish musical or incantatory impacts.

“Freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed” declared by an influential leader Martin Luther King Jr. As a soldier againsts unfairness, King strongly states that people should fight for freedom. Driven by human nature, humans are always chasing freedom. In “A Century Later,” the Pakistan-born British poet Imtiaz Dharker uses the poetic devices of symbolism, diction, and allusion to explore how perseverance drives freedom.