Role Of The Medical Insurance Specialist - 1322 Words

The role of the Medical Insurance Specialist is very important to the financial operation of a doctor practice, hospital or other medical facility. A Medical Insurance Specialist collects all the information necessary to prepare insurance claims, enter patient demographics and insurance information, enter ICD codes and CPT billing codes, research, correct and resubmit rejected and denied claims, bill patients and answer patient questions regarding charges. The billing process is actually the process of communication between the insurance specialist, medical provider, patient and the insurance company. This is considered the billing cycle. The billing cycle could takes days to complete or it could take months. The patient demographic†¦show more content†¦Thompson (2015) also stated that the insurance specialists always call to verify secondary insurance information and rejections. The rejections may be due to incorrect modifiers, codes or an incorrect insurance ID numbe r. The third step in the process is the healthcare provider examining the patient and recording the patient symptoms and treatment. This is recorded and the medical coder or billing MEDICAL INSURANCE SPECIALIST COMMUNICATION 3 specialist determine the ICD, CPT or HPCS coding. The coder or biller may have to communicate with the healthcare provider if there are any questions on any of the diagnoses, treatments or duration of the office visit (Dietsch, 2011). Because insurance companies are very strict on correct medical billing and coding, a small mistake can cause the insurance company to deny the claim and will then require the doctor to fix the error and the claim will need to be resubmitted (Cocchi White, n.d.). The fourth step is the charge entry, this is where the bill is created. An account is set up for every patient with the demographics and the account is assigned a number. While talking to B. Mcleod (personal communication, May 26, 2015) it was also stated that one of the key functions for charge

A Permanent Solution Of A Temporary Problem - 1224 Words

â€Å"A Permanent Solution to a Temporary Problem† Hannah Smith was 14 years old when she decided she didn’t want to live anymore. She took her last breath before she hanged herself on August 2, 2013. Hannah was cyber bullied on the website Ask.fm, and her family believes the bullying triggered her suicide. The cruel messages were sent anonymously to Hannah, and some even told her to she should kill herself (Smith-Spark). Her father, David Smith , grievingly asked, â€Å"how many more teengers will kill themselves because of online abuse before something is done?† (â€Å"Hannah Smith†). Unfortunately, Hannah wasn’t the first or the last victim of suicide . Suicide was the tenth leading cause of death out of all ages in the United States of the†¦show more content†¦Learning and understanding more about the infinite causes of suicide in teens and young adults can help people prevent others from committing this dreadful act. Teenagers and young adults who suffer from mental health illnesses, such as depression, anxiety, bipolar disorder, and insomnia, are at a greater risk of suicide and suicidal thoughts (About Suicide). Megan Fickert, a sophomore at Fairmount High school, killed herself after suffering from depression since fifth grade. Her mother, Michelle Fox, reflected, â€Å"Megan has been sick for years, and I’ve been trying to get her help for years.† Her family assured bullying wasn’t a factor. Her brother, Kevin Fickert, pondered â€Å"Nobody really knows why. We’ll never know† (McCarthy). About 95% of people who die by suicide have a psychological disorder -- such as depression -- at the time of death (About Suicide). Depression is a mental disorder that affects more than 20 million people in the United States. The symptoms of depression are: sadness, loss of interest or pleasure in activities on use to enjoy, change in weight, difficulty in sleepin g or oversleeping, energy, feeling of worthlessness, and thoughts of death or suicide (â€Å"Depression...†). Depression is not just caused by one sole reason, but from several factors which vary from person to person. Major life changes -- such as the death of a loved one, a divorce,

MAS 500 operating system Free Essays

MAS 500 operating system can increase efficiency in management. It was built up with Microsoft office and Visual Basic and has been seen as good financial accounting software. (Sage software) MAS 500 can integrate business intelligence; order processing, distribution and manufacture (Sage software) and is designed to help companies manage operations. We will write a custom essay sample on MAS 500 operating system or any similar topic only for you Order Now The software is dependable and reliable and covers all areas of e –business and can support large volumes of data and respond to growth in the business. (Tech target. 2008) MAS 500integrates with other applications and can be customised without programming. (Tech target. 2008) The disadvantage in its implementation is the cost involved to purchase the software and then train staff to use it. However, with the increased efficiency MAS 500 is often seen as a good investment reducing costs in the long run. The time taken to upgrade can be seen as a disadvantage as it cuts into business profits. MAS 500 have been seen that leading companies have taken this new software. Fortune Brands has upgraded and MAS 500 performs general ledger, accounts payable and cash management tasks. (Best software, 2003). MAS 500 can automate areas of business management such as core and advanced financials, customer relationship management, project accounting, time and expense tracking, wholesale distribution, discrete manufacturing, warehouse management, human resources, payroll, e-business and business intelligence. (TechTarget. 2008)MAS 500 is user friendly and allows most companies to run it quickly in less time then previous soft wares. (Best software, 2003) Thus the cost constraint would eventually be outweighed by the many benefits this software has to offer. References Best software (2003) A most admired company selects MAS 500 and ASP. Retrieved from the World Wide Web on the 14Th of November 2008:http://whitepapers. silicon. com/0,39024759,60040974p,00. htm Sage software. Sage MAS 500 retrieved from the World Wide Web on the 14Th of November 2008: http://www. sagemas. com/products/sagemas500/ Tech Target. (2008) Sage Software. Sage MAS500. Retrieved from the World Wide Web on the 14Th of November 2008: http://www. 2020software. com/products/Sage_MAS_500. asp How to cite MAS 500 operating system, Papers

Health Practitioner Regulation Agency †Free Samples to Students

Question: Discuss about the Health Practitioner Regulation Agency. Answer: Introduction Nursing and Midwifery Board of Australia (NMBA) and Legislated Registration Standards undertakes the regulation and functioning of nursing practice and midwifery in each state in Australia and identify their key roles in protecting the public. Qualified nurses and midwives who apply for registration in NMBA are assessed against these registration standards for the fulfilment of requirements for practicing nursing and midwifery in Australia. The Legislation Registration Standards are approved by NMBA for seeking of initial registration like English communication skills, recency of practice, Professional Indemnity and criminal history. Therefore, the following report involves the exploration of these registered and regulatory management standards and its application in the future nursing practice as an Enrolled Nurse (Nursingmidwiferyboard, Australia, 2017). NMBA functions as outlined by Health Practitioner Regulation National Law carries out function in each territory and state regulating the nursing practice midwifery In Australia with a major objective of protecting public. The function of NMBA include registration of nursing and midwifery practitioners and nursing students, development of nursing guidelines, standards, codes for the nursing and midwifery practice and profession. They also handle complaints, notifications, disciplinary hearings and investigations in the nursing practice. The assessment of overseas-trained practitioners is also done by NMBA who wish to practice nursing in Australia. The Accreditation standards are approved and accreditation of nursing course of study is also done by NMBA supporting the work of the National Board in national scheme in Australia (Nursingmidwiferyboard, Australia, 2017). In Australia, ANMF is the largest union having around 249,000 members. It is run by nurses, assistants and midwives in the profession of nursing for the advancement of political, industrial and professional status. It has active and strong branches in each territory and state throughout Australia. The role of this federation is to provide high quality, accessible and affordable healthcare services to every Australian in every healthcare setting whether remote or rural, big or small hospitals. Protection of public and patient safety and care are the priorities of ANMF. The body stands for high quality care and universal healthcare to patients and make the nurses, assistants and midwives understand their roles in nursing practice. ANMF is fighting for the rights of Australians ensuring that Medicare remains free and health bureaucrats and politicians understand the funding for healthcare as a priority. ANMF prioritize to provide highest level of healthcare services and mainly focus on preventative care to reduce the burden of disease in Australia. ANMF fights for the rights of nurses in Aged Care shifts and make improvements for graduate nurses ensuring that they gain employment after their completion of qualifications and degree (Lee Thomas Annie Butler, 2017). Registration standard: Continuous Professional Development (CPD) This registration standard in NMBA sets out minimum requirements for nurses for continuing their professional development for registered nurses, enrolled nurses and midwives. To meet this registration standard, one must complete minimum 20 hours in CPD per registration period. The registered or enrolled nurse needs to complete the minimum CPD requirements for nursing and midwifery practice in Australia. This standard looks into the maintenance, improvement and broadening of nursing profession in their knowledge, competence and expertise. It also helps nurses and midwives in the development of qualities required for the nursing profession at personal and professional level. This registration standard evaluates the completion of CPD requirements of registered nurses or nurse practitioners who is holding an endorsement ("Australian Health Practitioner Regulation Agency - Continuing professional development", 2017). This regulation standard evaluates the criminal history of any nurse or midwife who is applying for registration in NMBA in all countries including Australia. On the behalf of NMBA, the main role of this standard is to check the criminal history management of an applicant during the registration process ensuring that only those applicants (nurses and midwives) are selected who are safe and suitable for registration and nursing practice in Australia. This standard checks that all nurses and midwives who are registering for nursing practice must be free from any offence punishable by 12 months of imprisonment. In addition, criminal history standard also checks that whether convict or found guilty of an offence is punished by imprisonment in Australia or overseas ("Optometry Board of Australia - Criminal history", 2017). NMBA has set out this standard to evaluate that all the applicants who are applying for initial registration are capable of demonstrating English language skills and thus, are suitable for registration. The role of this standard is to set out how the applicant has the capability to demonstrate English in their communication and competency to the Board that is sufficient for practicing nursing or midwifery. Two English language skills are registered in the standard that comprises of common English language applicable during initial registration and NM English language skills applicable for all nurses and midwives ("Nursing and Midwifery Board of Australia - English language skills", 2017). Registration standard: Professional Indemnity Australian Health Workforce Ministerial Council approves this registration standard stating that no nurses and midwives who have not covered appropriate professional indemnity insurance (PII) arrangements are allowed to practice in their respective profession. The board has approved appropriate PII guidelines in conjunction with NMBA standards. The standard checks that whether registered health practitioners hold PII arrangements that is important part of National Scheme in protecting public and addressing of risk posed by practitioners who are uninsured. PII covers civil liability, unlimited retroactive and runoff in different types of nursing practice. Nurses and midwives who are holding insurance coverage in their own name are required to retain and show documentary evidence of PII or any insurance arrangements to the Board ("Nursing and Midwifery Board of Australia - English language skills", 2017). This standard means that a nurse or midwife should maintain adequate connection with the recent practice in their profession for which they are obtaining registration. The standard evaluates that the applicant is carrying valid and current nursing or midwifery registration either in Australia or overseas. It also sets out the role of nurses or midwives applying for registration whether they possess appropriate skills and qualifications relevant in their area of practice in nursing ("Australian Health Practitioner Regulation Agency - Recency of practice", 2017). This standard includes core practice guidelines providing a framework for the nurses for the assessment of enrolled nurse (EN) practice. NMBA sets out three domains under this standard that demonstrates that EN should work in collaboration with registered nurses, work towards provision of care and reflect analytical practice. This standard assesses the knowledge, capabilities, attitudes and skills of enrolled nurses within the clinically focused domains ("Australian Health Practitioner Regulation Agency - Recency of practice", 2017). Safe and competency are two core pillars of Code of Professional Conduct for Nurses in Australia. As a part of the decision-making framework if a nurse is not aware of the technique of certain procedure, she is free to take help from other experienced nurses in order practice in accordance with the nursing standards. I was not aware of the insertion of nasogastric tube so I preferred taking help and guidance from the experienced nurses in that ward (Nursing and Midwifery Board of Australia, 2017). Identified Learning Needs Observation of the patients condition both before and after is the principal observational approach that must be undertaken while inserting a nasogastric tube. Here the observation of the condition encompass, proper tabulation of the body temperature, blood pressure level, respiratory rate, pulse rate, heart beat and the level of oxygen saturation. After the successful insertion of the nasogastric tube, the actual position of the tube inside the body must be radiologically confirmed and with the pH balance (less than or equal to 5). If the patient has a previour reported cases of oesophageal varices or other chronic coagulopathy then, I learned that the insertion of the nasogastric (NG) tube must be undertaken under the supervision of a professional radiologist. Patients with dry mouth syndrome, moistening of the buccal cavity with a moisten cotton bud is must. In spite of taking several preventive measures, the insertion of nasograstric tube might feel uncomfortable for certain patients. During the course of my learning process, I came to know that in order to increase the comfprt quotient, Lidnocaine gel can be use either in from of gel (inside the nostrils) or in form of spray at the back side of the throat. However, Lindocaine gel is associated with certain degree of allergic symptoms to smaller group of patients, so allergic test is must before the use of the gel. The standard process of NG tube insertion is based on the guidelines NSW, Ministry of Health, Australia. In order to assist insertion, the patient must be postured in an upright position with optimal neck/head alignment. The nostrils needs to checked in order to detect the presence of any deformity as this ill guide the best possible way of insertion. Not only this accurate measurement from the tip of the nose up to the earlobe and xiphisternum needs to be taken in centimetre calculations and then simultaneously marked over the NG tube. After the measurements are done, the tube must be lubricated adequately and then only it should to inserted within the nostrils. After insertion, the positioning must be reconfirmed via the use of radiography. If in any case, a patient is found coughing profusely or experiencing sound breathing problem then the entire insertion needs to redone on an immediate basis. However, it must also be noted that absence of coughing syndromes, do not necessarily means that tube placement has been done successfully (Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017). During the course of my training, I also learnt that the faulty insertion of the NG tube can generate trauma in the adjoining areas along with pneumothorax. Other threats of incorrect insertion of NG tube include aspiration along with tube dislodgement, occurrence of pneumonitis. Pneumonitis occurs when the nasogastric feed get deposited inside the pulmonary cavities. In rare cases, due to error in insertion, the tube can get misplaced inside the lungs. This kind of fatal occurrence is common among the patients with cribriform plate disruption intracranial insertion ((Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017). As a trainee nurse, I have gained huge knowledge regarding NG tube insertion as a part of the continuous professional development (Nursing and Midwifery Board of Australia - Continuing professional development, 2017). When I will start my career as an registered nurse via gathering experience from my training session, I will always keep in mind that the patients who are critically ill or at a palliative care unit are more susceptible of getting affect with the NG tube complications. Moreover, I will also remain alert that when I am inserting a NG, I must do that in zero reflexes. Any negligence in this level can cast fatal harm to the patients. For the patients with impaired blood clotting syndrome and tracheostomy, I will observe extra caution. Lastly, fine bore NG tube may cause leakage of the gastric content causing fatal oesophageal erosions, the conditions are more severe with patients who are suffering from gastro-oesophageal reflux disease (GERD). I will never forget to refrig erate the NG tube prior insertion (Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017). Conclusion Thus from the above discussion it can be stated that a nurse must practice according to the norms of Nursing and Midwifery Board of Australia (NMBA) in order deliver quality care to the patients. Nurses must also abide by the registration standards of the NMBA in order to successfully qualify as a registered nurse. References Australian Health Practitioner Regulation Agency - Continuing professional development. (2017).Ahpra.gov.au. Retrieved 8 November 2017, from https://www.ahpra.gov.au/Registration/Registration-Standards/CPD.aspx Australian Health Practitioner Regulation Agency - Recency of practice. (2017).Ahpra.gov.au. Retrieved 8 November 2017, from https://www.ahpra.gov.au/Registration/Registration-Standards/Recency-of-practice.aspx Fine Bore Nasogastric Feeding Tubes for Adult Policy. (2017) (pp. 1 to 8). Australia. Retrieved from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments Lee Thomas, A., Annie Butler, A. (2017).Australian Nursing Midwifery Federation.Anmf.org.au. Retrieved 8 November 2017, from https://anmf.org.au/ Nursing and Midwifery Board of Australia - Continuing professional development. (2017).Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Continuing-professional-development.aspx Nursing and Midwifery Board of Australia - English language skills. (2017).Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/English-language-skills.aspx Nursing and Midwifery Board of Australia - Home. (2017). Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/ Nursingmidwiferyboard, Australia. (2017).Nursing and Midwifery Board of Australia - Home.Nursingmidwiferyboard.gov.au. Retrieved 8 November 2017, from https://www.nursingmidwiferyboard.gov.au/ Optometry Board of Australia - Criminal history. (2017).Optometryboard.gov.au. Retrieved 8 November 2017, from https://www.optometryboard.gov.au/Registration-Standards/Criminal-history.aspx