assignment 4

Write a 3-4 page paper in APA format (not including the cover page and reference page) and respond to the questions below. Be sure that your writing is clear and spelling and punctuation is correct. Remember that your punctuation and spelling could affect a patient’s health care. Please click here to view the criteria by which you will be assessed for the achievement of the CLO for this unit.

Please use the APA Essay Template that is posted in the Additional Resources for the course to complete your assignment.

A. A 35-year-old male patient is scheduled for a vasectomy tomorrow. It is within your scope of practice to provide preoperative instruction and you feel confident in performing this task. When you introduce yourself and explain what you are going to do, the first words out of the patient’s mouth are “How do you know what this is all about? I am the one who is getting things cut!” How would you respond to this patient?

B. Recall John Miller from the case study at the beginning of Chapter 16.

1.Dr. Buckwalter asks you to book a cardiac catheterization for Mr. Miller. This is a day stay procedure performed at the local hospital by Mr. Miller’s cardiologist. What information will you need to convey to Mr. Miller, and how will you do so?

2.Mr. Miller has a Medicare replacement plan that requires Dr. Buckwalter to obtain a prior approval for this procedure from the insurance plan. What type of information would you expect the insurance plan will need from you to issue this approval?

C. Recall Sylvia Gonzales from the case study at the beginning of Chapter 17.

1.In this state, each employee’s insurance plan is considered primary for him or her, which means Mrs. Gonzales’s HMO is her primary payer and the $25 copay from her last visit is now past due, because she wanted this submitted to her husband’s insurance. Insurance company refused coverage because of a $1,000 yearly deductible, which has not yet been met. How will you handle this?

2.What policies should be implemented now that you know that Mrs. Gonzales’s secondary insurance will not cover her copayments until her high yearly deductible is met?

D. Recall Cindy Chen from the case study at the beginning of Chapter 18.

1. You receive a call from Cindy, who is quite upset. She has just received an EOB from her insurance company clearly stating a diagnosis of AIDS. Although HIV positive, she has not been diagnosed with AIDS. How will you help Cindy’s immediate concern of her diagnosis?

2. In looking at Cindy’s insurance claim, you see that the new coder did indeed use the diagnosis code for AIDS instead of HIV. How can this be corrected with the insurance company? What will you say to the coder regarding the need for accuracy when coding any claim?