Re: Topic 3 DQ 1

Great post Alyssa. Advance directives are established to guide decision-making in times when patients are unable to make rational, effective, and abiding decisions for their healthcare (Tjia et al., 2018). Thus, it is essential for nurses to inform critical care patients on the need for advance directives to help in decision making in their future. In the absence of advance directives, the ethics committee becomes necessary in making important decisions for the patient. The engagement of the committee is important in ensuring that patients’ rights are respected in the provision of care and that their healthcare needs are addressed adequately and effectively.

References

Tjia, J., Dharmawardene, M., & Givens, J. L. (2018). Advance directives among nursing home residents with mild, moderate, and advanced dementia. Journal of Palliative Medicine, 21(1), 16-21. https://doi.org/10.1089/jpm.2016.0473

Hi I need to reply to this post, can you help me with it?

1. Prepare examples of various coding and billing issues that you have experienced in the clinical setting (Peds and women’s health).

2. Provide a brief description about the NPI numbers for nurse practitioners.

Answer: 

According to the American Academy of Pediatricians. (2020), current Procedural Terminology (CPT) has specific guidelines for using time as a key factor in determining the level of evaluation and management (E/M) service. First, it is paramount to remember the key factors in determining the level of CPT code which include history, physical examination, and medical decision making for the service. The level of selecting most E/M codes would be determined by these three key factors. In the pediatric practice, pediatricians’ needs to take into consideration the additional time they spent with patients, because it might change the level of coding that is used. On the other hand, time is the key factor when the counseling, coordination of care, or both account for more than fifty percent of the face-to-face time with the patient and/or family. When this situation occurs, it is necessary to enter the total duration of counseling and/or coordination of care into the clinical notes, as well as a description of the counseling and/or coordination of care that took place.

 For example, this future practitioner has performed a detailed history and examination, with the decision making as low complexity, and sixty minutes are spent with the patient; forty minutes of which are spent counseling the patient, the visit is coded 99205 which CPT guidelines indicate has a typical time of 60 minutes rather than 99203, which CPT guidelines indicate has a typical time of 30 minutes, for a new patient. (AAP, 2020). Besides, other issue in the office and other outpatient visits is that face-to-face time is defined as the amount of time the practitioner spends in the room with the patient. It does not include any other nurse time preparing the patient or giving injections. Coding to a general level or under coding could lead to a rejected or denied claim.

The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). The numbers do not carry other information about healthcare providers. As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that might need it for billing purposes

References

American Academy of Pediatricians. (2020). Coding Tips for Pediatricians: Evaluation and

Management Coding Strategies. Retrieved from https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Coding-at-the-AAP/Pages/Coding-Tips-for-Pediatricians-Evaluation-and-Management-Coding-Strategies.aspx

American Academy of Pediatricians. (2020). 2020 Coding and Reimbursement Tip Sheet for

Transition from Pediatric to Adult Health Care. Retrieved from https://www.gottransition.org/resource/? 2020-coding-tip-sheet

CMS. 2019. National Provider Identifier Standard (NPI). Retrieved from

https://www.cms.gov/Regulations-and-Guidance/Administrative-  Simplification/NationalProvIdentStand

REPLY1

(This is the feedback from my professor to my prompt)

Marial, 

Thanks for sharing this situation with us and how you were able to show the integrative negotiation process that ended in a win-win situation and potential salary increase. This week we also learned about distributive negotiation and “fixed-pie.” Share with us in your own words what “fixed-pie” is and why it does/does not apply to your situation that illustrated integrative negotiation.

REPLY2

On this week’s task we have to research about integrative negotiation and bargaining. One of the main important things to do is to define the situation because it is important when helping to determine what you will be negotiating your issues to complete a solution. Interest are also the primary factor of integrative negotiation. Being able to identify your own interest and those of the other party and being able to find a solution for all parties it’s a good thing when it comes to negotiating. 

Food Server: Incorrectly submitted an order for a vegetarian couple, their meals were sent to the table with chicken.

Couple: Demanded to Speak to a manager.

Manager: invites them to have a conversation in a private location to listen to their concerns.

Couple: When they were finished addressing their concerns, they proceeded to add that a Birthday dinner was ruined as they were served chicken when they are vegetarians.

Food Server and Manager: Discussed with the couple different ways to compensate them for the unfortunate experience that took place. 

Couple: Explained they did not want a free or discounted meal, they wanted to ensure situations like that didn’t happen again and that employees have proper training. 

Manager: Proudly informed them of their rigorous training program. He also made sure to inform them that the servers are human, and they do make mistakes. 

Couple: Agreed with the manager but informed him that mistakes very dangerous like this shouldn’t happen.

Manager: Informed the general manager of the situation because they wanted to make things right even though the couple refused to any compensation. General manager sent the couple a $100 gift certificate and a formal letter of apology for failing to meet their expectations. 

Couple: Decided to accept that humans make mistake and took them up on the offer and gave the restaurant a second chance.

Aggressiveness is not inappropriate when negotiating integratively. Digging deeper to find relevant information and standing in what you believe in to be able to negotiate properly can really help. Also, separating the person from the problem and recognizing and understand that emotions are an inevitable part of the bargaining process. “everyone involved in the negotiation process works together to generate as many possible solutions to the problem as possible” (Friedman, 1998).

REPLY1

(This reply is for my professor)   

she wrote this feedback for my)      

Hello Maria. Reflecting on your area of nursing expertise, what has been your experience with working within an interprofessional team? Did you have an opportunity to speak up on behalf of your patient but failed to do so? If so, what prevented you from speaking up and how would you handle a situation similar to this should it arise in the future?

REPLY2

  Interprofessional collaboration is the collective involvement of various professional healthcare providers working with patients, families, caregivers, and communities to consider and communicate each other’s unique perspective in delivering the highest quality of care. (Moss et al, 2016) At work, I saw a physician did not wash his hands before and after seeing a patient who I was taking care of. The doctor was busy, and I was afraid to interrupt him. I knew I should have told him that washing hands is important to prevent the spread of infections between patients. However, I was not able to tell him about it because of the fear. Hesitancy to speak up is one of the factors that may contribute to communication errors and/or adverse events. (Okuyama et al, 2014)

           According to Okuyama et al (2014), effective communication and teamwork skills are crucial to improve patient safety for health care professionals. Health care professionals are expected to speak up about their concerns before a critical event reaches a patient to provide a chance to correct the plan or intervention. (Okuyama et al, 2014) In addition, establishing a culture that empowers staff to speak up when concerned about the quality or safety of patient care is important. The Michigan Health & Hospital Association (MHA) Keystone Center has implemented the Speak‐Up! Award program that acknowledges frontline health care staff for voicing their concerns and making care safer. (Novak, 2019) And this program presents evidence that fostering a psychologically safe culture of speaking up yields fiscal and humanistic returns, both of which are crucial to sustainable, meaningful progress in safety and quality. (Novak, 2019)

Have you ever been involved in a lease-or-buy decision at work? In your personal life?

Please describe this situation and be sure to include the following information:

• How did you approach making this decision? 
• What factors went into making the decision to lease or to buy?
• In hindsight, do you think that you made the right decision? 
• Do you think that you made the cost effective decision?