Replacement Insulin Pump (E084)

Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended

The carrier has denied coverage of Novolog 100 unit/ml cartridge as not medically necessary. There is a letter from the carrier to the member dated 03/23/2016 which states in part:

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was created, in part, to make health insurance portable in an attempt to address the problem of the growing amount of people that are uninsured and underinsured (NASW,2002). The Act allows a person with preexisting medical issues to get health

The carrier’s decision in denying coverage for the requested prescription medication, Harvoni 90mg - 400mg, was appropriate for the treatment of this member’s condition.

The confounding factor is that people do not always respond to information and make choices based on common rationale. For example research demonstrates that 1 in 5 prescriptions go unfilled after a treatment plan has been provided by a physician. Among patients being treated for chronic conditions such as diabetes, medication adherence is actually lowest. NEHI research estimates cost of medication non-adherence at 290 billion dollars annually in the U.S. The National Diabetes Prevention Program cites nearly 29 million people in the U.S. have diabetes which cost the U.S. healthcare system 176 billion dollars in 2012, despite diabetes being largely preventable with diet, exercise and not smoking. These and other examples such as missed physician appointments, misuse of emergency care services, and lack of commitment to healthier lifestyles demonstrates complexity in managing the human aspect of healthcare. If population health management programs are to be successful they must be able to effectively support various risk cohorts of patients in making decisions to maximize benefits from healthcare services. As healthcare organizations increase focus on keeping patients healthy, many organizations are questioning the most effective use of technology and support services to enable better decisions regarding health

HIPAA compliance and technology use: In 1996 when Health Insurance Portability and Accountability Act (HIPAA) was enacted HIPAA compliance and the use of technology was not given that much importance as it is today. Only small percentage of people owned mobile phones twenty years ago which didn 't have a lot of capabilities of communicating except the basic text messaging. Twenty years later the mobile device technology is much advanced and has much more capabilities and much faster than imagined. Advanced capabilities include messaging, internet access, e-mails and ability to take pictures and be able to send using the mobile device.

Do not see medical record documentation of use for an FDA approved indication (Pain, acute, Due to

Ms. Coats is appreciative of her Medicare but states, “it does have its drawbacks.” While having knee replacement she developed blood clots in her lungs and Congestive Heart failure in which she gained seven pounds in two days. After the doctors had started to get this under control, they wanted to send her to the Hospital

The province of Ontario has strongly implemented the use of smart pump to reduce medication errors and provide a better service to a patient. Furthermore, it will minimize injuries and death claims caused by an overdose. Although, there is still some areas in Ontario that does not follow the suggested machine to be used on their facilities and some are still in process which it will help to increase the percentage rate of ensuring that the patients will receive an excellent service in the field of medicine. Moreover, it will increase the chances of having the patients going home to their own places since they were able to receive a proper medication that would potentially help them recover quicker by getting the intended medication provided

“I’m so sorry Mrs. Jones, but your insurance doesn’t cover that.” My mother stood, staring in disbelief at the $850 invoice that she received for her C-Pap machine. She had no clue how she was going to pay for it since her only income is her monthly social security disability disbursement, which is only $850. She desperately needed this machine for her Sleep Apnea but how would she afford this when she has so many other expenses? Why isn’t Medicare covering the cost of this machine? They covered the hospital stay that led to the diagnosis, so why not this? This scenario and similar ones present themselves far too frequently. As a solution, let’s discuss the basics.

HIPP grants are available to every ESRD patient in the U.S. who has a documented financial need based on their income to debt ratio for paying primary and/or secondary health insurance premiums and who would lose coverage without the assistance of AKF. Each year, this program helps ESRD patients from all 50 states, the District of Columbia, and the U.S. territories maintain access to all of the life-sustaining healthcare benefits covered by their insurance plans. HIPP grants are available to cover premiums for health insurance coverage under Medicare Part B, Medigap, Employer Group Health Plans, Consolidated Omnibus Budget Reconciliation Act (COBRA), and commercial insurance plans including those within the Marketplace exchanges and Medicaid where states require residents to pay premiums.

Call Dr. Apperson and speak with the provider about the grandmother’s ability to assist Shyann in monitoring her diabetes.- 12/28/16

The medication error involved an 85 year old female. She was discharged from the hospital after an open reduction and internal fixation surgery for a fractured hip. Upon her arrival to the nursing home facility, there were multiple opportunities to prevent the medication errors that eventually lead to her fatal cardiac arrest. There was a lack in communication between the patient’s medical team. After the patient was discharged there was no follow up from the hospital nor a nursing care plan at the patients’ nursing home. The individuals did not use any critical thinking skills in going beyond the five rights of medication administration. There may have been a lack of knowledge of the medication. Since the patient had a history of

Medicare law permits installment just for administrations or supplies that are viewed as sensible and meaningful for the expressed finding. Medicare won't cover systems regarded to be a trial in nature. There are cases in which the supplier verifies that medications or administrations are ultimately advocated, and such treatment choices are then disclosed to the patient, who must pay the full cost of the non-secured system.

I need some help for one WSFH patient. Pt came to office with a bill from Labcorp DOS 1/5/16, for a porstate specific AG. serum. One of our Enrollment Specialist Called Labcorp and spoke with Kathy who stated that in order for insurance to pay for procedure the doctor needs to add an additional diagnostic code, because insurance does not want to pay for procedure. Do you think you will be available to pass this information to your billing department so they can do the appropiate corrections Please. Let me know if the billing department will be available to do the corrections b/c the patient is very worry about this bill collection.