G4S has been the vendor at the AJAC facility since 2007. During the first seven years of our service to the state we had no issues receiving payment for the medical services we provided via our contract with DYS. On March 24, 2014 Steve Little sent an email to our team outlining his interpretation of the requirement in our contract that G4S receive “approved Medicaid rates” for medical services. In the email Mr. Little referenced the section of our contract which states “the contractor shall further insure that all medical, dental, and mental health services are secured from a Medicaid approved provider and that charges for services shall be at the Medicaid approved rates. If no Medicaid provider is available the contractor must make every …show more content…
This was the way the contract had been interpreted from the beginning of our time in Arkansas until Mr. Little’s March 24, 2014 email. Mr. Williams told us that beginning July 1, 2014 that we were to email him at the beginning of the month with a list of the non-Medicaid, and non-Medicaid rate vendors and the current appointments we had for those vendors. We were also directed to state “subject to change” in the email, and that would cover additional youth appointments that needed to be made with those approved vendors. Mr. Little’s May 13, 2014 email (Exhibit 2) specifically required vendors to submit a list of requested non-Medicaid rates for the services each vendor would provide. In follow-up conversations with Mr. Williams our team explained that it would impossible to submit these rates in advance, unless we submitted the rate for every possible procedure a vendor could potentially provide. The process outlined in Exhibit 2 would be fine if we made appoints for youth for a specific service, and that was the only service provided. However, anyone who has ever had a doctor’s appointment understands that during an examination a doctor has the discretion to order additional services or tests based upon their initial
needed to create the factory GEL will look for investors to help with the construction of the cost of the factory.
In Task 2, the owner is correct in his need to move away from a sole proprietorship and into an entity where his personal assets will be shielded in the event of a business failure. There seem to be three major ways to remove this liability, which include a C-Corp, S-Corp and LLC. For this situation, I would recommend an LLC for the business owner and will explain why it will benefit him in the issues of liability, continuity, income taxes, profit retention and control.
Nightingale Community Hospital identified a recent sentinel event involving the ambulatory surgical center. A sentinel event is defined as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof (http://www.jointcommission.org/sentinel_event). A three year old female presented to the hospital on September 14th for a planned outpatient procedure. The child was accompanied by her mother. The mother registered the patient with the registrar prior to the procedure. The patient and her mother went to the pre-operative area to complete the informed consent and the necessary physical assessment. The pre-operative nurse obtained the necessary contact
Patient within this category, such as cardiac arrest, respiratory arrest, extreme respiratory distress are imminent risk of deterioration. Thus, these types of patient must be seen immediately. (Hodge et al., 2013)
Kindergarten classroom of 25 students they all sit at tables that will hold up to six students, however I have them sitting 5 to a table for ease of grouping. Each table is a team labeled by a color, a large construction paper crayon hangs from the ceiling above each table, and they have matching crayon nametags on their desks. There is a Smart Board at the front of the classroom as well as a white board. My desk is at the front of the room to the right of the white board. Different centers are located around the room such as the art center, the math center, the reading tree is in the opposite corner from my desk. The room also has a single restroom and a sink and water fountain outside of the restroom. We also have circle area to the left of the reading corner
This report demonstrates the current financial situation for the Stratton Township Park and makes recommendations for the annual program budget for the next fiscal year. We first show the current annual budget program, indicating line-item details for each function by account and summarizing the park budget as a whole. Second, we find the break-even points for the golf course green fee and the pool admission to determine what the park would have to charge in order to cover expenses of the these operations. Next, we calculate the marginal revenues and expenses to determine the impact of shutting down certain programs in the park. Lastly, this report prepares the revised budget for the upcoming fiscal year based on our recommendations.
The disease process I will be reviewing is traumatic brain injuries. A traumatic brain injury occurs when sudden trauma occurs to an individual’s brain. Traumatic brain injuries are considered closed or penetrating. Traumatic brain injuries are categorized as mild, moderate or severe based on the amount of damage that occurs to the brain. (ninds.nih.gov, 2015)
A. Nurse sensitive indicators are factors that are directly impacted by nursing. There indicators fall into three categories; structure, process and outcomes of nursing care. The structure indicators are the organizational piece of nursing care. These relates to the amount of staff on duty at a given time, how many RN's are on duty and experience level of the staff. For example, evidence indicates institutions with a higher number of RN’s possessing a Bachelor Degree in nursing result in improved patient outcomes. The process indicators measure nursing care such as patient assessment, patient care and intervention. These are the organizational policies and procedures of nursing. The patient outcomes are indicators directly related to
After reading over the material in chapter 14, it is my opinion that selective contracting should not be allowed to exist between providers and payers. Utilizing selective contracting puts both the payer and the provider in a position to possibly limit the quality of care actually needed by the patient for their own benefit. This benefit doesn’t necessarily have to be in the form of a financial gain, but could merely be in the form of a financial security. Selective contracting appears to place of great deal of power within the hands of the payer, who now has the power to control fees charged by providers, through controlling which providers make it on their list of in plan providers.
* Medicare/Medicaid, to be sure the doctor is not banned from caring for Medicare/Medicaid patients
Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the
The external stakeholders are the community, patients, MedKey System members, CMS, HMOs (ie. Blue Cross Blue Shield and Tri-Care), and any other private insurances (Richards & Slovensky, 2004). Medicare reimbursement in Alabama was the lowest rate in the nation. This was a constant struggle for the hospital administrators to try to operate on such low reimbursements for their services, which is a threat. Eighty percent of patients were Medicare or Blue Cross in which there was difficulty-negotiating prices with Blue Cross due to monopoly. Buyers have high bargaining power as reimbursements rates are low from Medicare and Blue Cross held monopoly in the services area so negotiating prices was difficult. Suppliers have lower bargaining power due to low Medicare reimbursements and difficulty negotiating prices with Blue
The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.
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 meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the Beneficiary Notices Initiative to alert the Medicare beneficiary prior to rendering the service. The Medicare beneficiary is notified via the Advance Beneficiary Notice (ABN) (see page 235 in Appendix B).
Medicaid provides a comprehensive benefit package for those who enroll. The federal government requires coverage of thirteen services, including inpatient and outpatient hospital services, nursing home and home health care, and for children under the age of twenty-one. The benefits do not end there, Medicaid offers a