Requirements:

Content Criteria:

  1. Read the case study listed below.
  2. Refer to the rubric for grading requirements.
  3. Utilizing the Week 3 Case Study Template Links to an external site., provide your responses to the case study questions listed below.
  4. You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
  5. You must use the current Clinical Practice Guideline (CPG) for the management and prevention of COPD (GOLD Criteria) to answer the classification of severity and treatment recommendation questions. The most current guideline may be found at the following web address: https://goldcopd.org/ Links to an external site.. At the website, locate the current year’s CPG and download a personal copy for use. You may also use a medication administration reference such as Epocrates to provide medication names.
  6. Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.

Case Study Scenario

Chief Complaint

A.C., is a 61-year old male with complaints of shortness of breath.

History of Present Illness

A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain. The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for which he did not seek care. He was evaluated by cardiology and underwent a successful and uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The cardiologist has requested that you, his primary care provider, evaluate him for further work-up. Prior to today, his last visit with your practice was 3 years ago when he was seen for acute bronchitis and smoking cessation counseling.

Past Medical History 

  • Hypertension
  • Hyperlipidemia
  • Atherosclerotic coronary artery disease
  • Smoker

Family History

  • Father deceased of acute coronary syndrome at age 65
  • Mother deceased of breast cancer at age 58.
  • One sister, alive, who is a 5 year breast cancer survivor.
  • One son and one daughter with no significant medical history.

Social History

  • 35 pack-year smoking history; he has cut down to one cigarette at bedtime following his cardiac intervention.
  • Denies alcohol or recreational drug use
  • Real estate agent

Allergies

  • No Known Drug Allergies

Medications

  • Rosuvastatin 20 mg once daily by mouth
  • Carvedilol 25 mg twice daily by mouth
  • Hydrochlorothiazide 12.5 mg once daily by mouth
  • Aspirin 81mg daily by mouth

Review of Systems

  • Constitutional: Denies fever, chills or weight loss. + Fatigue.
  • HEENT: Denies nasal congestion, rhinorrhea or sore throat.
  • Chest: + dyspnea with exertion. Denies productive cough or wheezing. + Dry, nonproductive cough in the AM.
  • Heart: Denies chest pain, chest pressure or palpitations.
  • Lymph: Denies lymph node swelling.

General Physical Exam  

  • Constitutional: Alert and oriented male in no apparent distress.
  • Vital Signs: BP-120/84, T-97.9 F, P-62, RR-22, SaO2: 93%
  • Wt. 180 lbs., Ht. 5’9″

HEENT 

  • Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.
  • Ears: Tympanic membranes intact.
  • Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.
  • Mouth: Oropharynx clear. No mouth lesions. Dentures well-fitting. Oral mucous membranes dry.

Neck/Lymph Nodes 

  • Neck supple without JVD.
  • No lymphadenopathy, masses or carotid bruits.

Lungs 

  • Bilateral breath sounds clear throughout lung fields. + Bilaterally wheezes noted with forced exhalation along with a prolonged expiratory phase. No intercostal retractions.

Heart 

  • S1 and S2 regular rate and rhythm, no rubs or murmurs.

Integumentary System 

  • Skin cool, pale and dry. Nail beds pink without clubbing.

Chest X-Ray 

  • Lungs are hyper-inflated bilaterally with a flattened diaphragm. No effusions or infiltrates.

Spirometry

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Discussion Week 3 – Ashby

From NRP-475-001-2021-010

No unread replies.No replies.

On page, 308 of Stanhope and Lancaster (2020) there is a table 14.1 labeled, “Factors that Can Influence  Disease”  which was adapted from a 1994 CDC model.

The categories include:

Societal Events—economic impoverishment, war or civil conflict, population growth and migration, urban decay

Health Care—new medical devices, organ or tissue transplantation, drugs causing immunosuppression, wide spread use of antibiotics

Food Production—sources of food, globalization of food supplies, changes in food processing and supplies

Human Behavior—sexual behavior, drug use, travel, diet, outdoor recreation, use of childcare facilities

Environmental—deforestation/reforestation, changes in water seco-systems, flood/drought, famine, global changes (warming, cooling)

Public Health—curtailment or reduction in prevention programs, inadequate communicable disease infrastructure surveillance, lack of trained personnel (epidemiologists, laboratory scientists, vector and rodent control specialists)

Microbial Adaptation—changes in virulence and toxin production, development of drug resistance, microbes as co-factors to chronic disease

 

Prompt:

Write a summary of what is currently known about the 2019-CoV virus.  Where did it begin?  When did it begin?  What are the symptoms?  How is it spread?  Where has the virus spread to (detection)?  How many cases have been reported (incidence)?  What is the mortality rate?  What populations have been impacted?  Who are most at risk?  Why are they at risk? What screening is currently taking place to control the outbreak? What is the current recommended treatment?  Why is it important to know if persons who have initially become ill have been near a food market where animals are kept (either alive or dead)?

In your response for this week, address the 7 categories that are listed above as they relate to the 2019-NCoV virus.   

Use the following guidelines for grading as you write your responses.

RN to BSN Weekly Discussions Guidelines & Grading Rubric 42018 (1).docx

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1) Discuss some common causes for coding errors and the preventative measures you can use to avoid them.

2) What are some other measures you can add to the list that might not be in the course materials?

3) What is the Fraud and Abuse Control Program? What is the HHS OIG and what is it’s major concern?  (Be sure to watch the video below.)

Please review the discussion board rubric found under “Start Here”.

 Use in-text citations appropriately and provide full citations for your initial post and at least one of your response posts.  One of your citations needs to be outside of your text.  

The idea is that you would not only comment on your classmate’s post but also do some additional research furthering the discussion.

To begin discussing in this forum, click the forum title, “Week 3 Discussion”. Then, click Create Thread on the Action Bar to post your initial reply. To reply to a fellow participant, click the title of the initial post, then click Reply.

Quetsy Garcia

discussion week 3

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Total views: 1 (Your views: 1)

  1. These are some of the most common causes for coding errors:
  • Incorrect coding
  • Upcoding
  • Unbundling of services
  • Billing for medically unnecessary services
  • Billing for services not covered under health plan
  • Duplicate billing
  1. What are some other measures you can add to the list that might not be in the course materials?
  • Reviewing to assure there is no incorrect information for the patient (name, sex, date of birth, insurance ID information, etc.)
  • Assuring insurance provider information is accurate (policy numbers, address, contact information, etc.)
  • Inputting the wrong codes or confusing codes such as CPT codes, point of service codes, or ICD-9-CM codes
  • Entering too few or too many digits for ICD-9-CM codes
  • Inputting mismatched treatment and diagnostic codes
  • Forgetting to input codes at all for services performed by a physician or another healthcare official
  • Not having access to EOBs on denied claims
  • Not verifying a patient’s insurance coverage
  1. What is the Fraud and Abuse Control Program? What is the HHS OIG and what is it’s main concern?
  • HHS is a Fraud and Abuse Control Program
  • OIG carries out nationwide audits and investigations. They have the authority to investigate basically any healthcare facility.
  • There primarily concern is to make sure business comply with principles of business practice and avoid healthcare providers committing fraud.

Aalseth, P. Second Edition Medical Coding 2015

http://www.medicalbillingandcodingonline.com/medical-billing-errors/

Dorothy Browning

week 3 discussion

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Total views: 7 (Your views: 1)

Coding Errors

Hospitals, physicians, and medical clinics depend on medical coding and billing to generate their income. Therefore, the coding specialists are the principal means of communication between medical providers and the insurance companies (Venezian, 1985). When errors are recorded during coding, claims may be uncompensated for, or a hospital may be forced to refile an application(s) before payment is initiated.

Causes of Coding Errors

Incorrect Medical Diagnosis

Incorrect medical diagnosis occurs when a code that is not compatible with a procedure is recorded. The error mainly ensues when there is a failure by the specialists to offer a diagnosis to the highest level or when there is an omission of the 4th or 5th digit during data entry (Venezian, 1985).

Error in the Medical Documentation

It occurs when there is a misunderstanding of the medical records and documents. Alternatively, this may happen when there is a missing billable procedure or the details required for billing.

Failure to Code to the Highest Level

The coding expert must encrypt a medical event or process to its highest degree of specificity, which requires abstraction of information from the medical reports and taking of accurate notes. Moreover, the professional should understand both the testing and diagnosis procedure of the ailment to be coded.

Strategies to Avoid Coding Errors

The most preeminent tactic that can be espoused by firms to impede errors is ensuring that the coding personnel is current on coding changes (Venezian, 1985). To achieve this, updated encryption manuals, publications, and organizing refresher training sessions for the staff members have to be provided. Moreover, the employees should be diligent since the coding job is detail-oriented and requires a thorough analysis of data presented. The errors can also be avoided by double checking the work upon completion to eliminate careless mistakes and possible omissions. Additionally, it is vital to ensure that there is communication between the coders, health professionals, and the insurance providers to facilitate clarification of ambiguous medical reports before coding is commenced.  Finally, the coders should avoid the use of truncated codes; they should present the patient’s diagnosis to the highest level of specificity (Venezian, 1985).

Other Approaches for Preventing Coding Errors

Apart from the above-highlighted measures of avoiding coding errors, the following methods can also be used to minimize the risks of inaccurate coding:

Follow up on claims. It is possible for an individual to avoid and anticipate errors by following up on the previous claims filed with the insurance company (Venezian, 1985). A representative from the insurer may help to single out an error, hence providing an opportunity to resubmit an application before it is processed and denied. Secondly, coders should read the entire progress reports rather than just skim through the header to capture diagnostic information and the nature of services provided. Though the header may summarize the procedure conducted, the treatment may change as the physician gathers more information about the patient during a diagnosis (Venezian, 1985). 

Fraud and Abuse Control Programs

Health Care Fraud and Abuse Control Programs are a stratagem that conceived to combat scams in health care by monitoring the delivery of services, medicals supplies, and equipment across the local, state, and federal governments (Wood, 2015). The program is directed by both the Attorney General and the Office of Inspector General, OIG. These departments are responsible for submitting annual progress reports to the Congress. HHS OIG is an acronym that is used to refer to the Office of Inspector General Department of Health and Human Services (Wood, 2015). This department is charged with the responsibility of identifying fraud and abuse of resources in Human Health Services, HHS, which harbors more than 300 health and safety programs. The main aim of HHS-OIG is to protect the beneficiaries of these programs while maintaining the integrity and delivery of health services (Wood, 2015). The program also indicts individuals who breach the law on federal insurance or embezzle health care funds.  

References

Venezian, E. C. (1985). Coding errors and classification refinement. The Journal of Risk and Insurance, 52(4), 734. doi:10.2307/252318

Wood, C. (ed.). (2015). The Health Care Fraud and Abuse Control Program: Issues, assessments and effectiveness. New York, NY: Nova Science , Inc.

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