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Identify key service lines of medstar and conduct a debt capacity study of medstar. 

Apa Style

References( follow paper instruction)

Free plagiarism

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.

Read the following article:

https://journals.lww.co m/jwocnonline/Fulltext/ 2012/03001/Reimburse ment_of_Advanced_Pra ctice_Registered.4.aspx

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

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

1. Evidence-based solution
2. Nursing intervention
3. Patient care
4. Health care agency
5. Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

  Communication 

1. strategy for developing communication   within a team

    Effective communication within a team

    How to handle conflict in communication

    Ineffective strategies when developing a   team

    How to maintain good communication

 Min of 467 words and no more than 500 words 

You will take on the role of a clinician who is building a health history for one of the following cases.

CASE STUDY: 

CHIEF OF COMPLAINT “I had a severe headache yesterday with difficulty to speak”

History of Present Illness (HPI) A 64-year-old African American female who reports having a severe pulsatile diffuse headache yesterday with sudden difficulty to talk with last for about two hours. She did not seek medical attention. This morning she woke up with no problems but is here today due her husband advise.

PMH: Atrial Fibrillation, Hypertension. Is allergic to Non-steroidal Anti-inflammatory drugs Aspirin

Drug Hx: Losartan 50 mg, Xarelto 15 mg BID

Subjective: Feels Palpitations, joint pain with yesterday’s episode

Objective Data

VS: B/P 131/80; temperature 98.2°F;  (RR) 18;  (HR) 84, irregular; oxygen saturation (PO2) 96%;

General: well-developed female, no acute distress

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition.

Lungs: CTA AP&L

Card: Irregular heart beat with normal rate

Abd: No tenderness normoactive bowel sounds x 4;

Rectal exam: Non contributory

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

Then answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.
6. What teachings will you provide?

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic source

This week’s first assignment is STEP 3 – Literature Review and Critical Appraisal.

The student will complete the following items and submit a Word doc to the assignment link. 

1. Provide a title that conveys or describes the assignment.
2. Literature Review – Provide the key terms used to guide the search for the evidence and provide at least five (5) summaries of research studies to support the evidence.
3. Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and any gaps in knowledge from the research evidence.
4. References – Cite a minimum of five scholarly references in APA 6th ed format.
5. 4-5 PAGES

Expectations

• Format: Completed paper with references in APA 7th ed. format
• File name: Save the file with Student First Name_Last Name_Part 3  

(PICOT Question;

For elderly patients above 60 years with pressure ulcers (P), will negative pressure wound therapy (I) as opposed to standard moist wound therapy (C) improve the healing of the pressure ulcer (O) during their two-week stay at the hospital (T)?)

IMPORTANT NOTICE

See attached paper as it has everything you are to do in this paper and you MUST use the Critical Analysis article to guide you in your analysis that is also attached; the EBP pyramid paper also attached.

• Use the paper you submitted in week 5 (part 2) as this may reflect what you will do for your capstone project. In this version of that paper, you are to do the following: (PUT THE PAPER IN A WORD DOCUMENT NOT PDF and NO APA templates as edits cannot be made to help you learn in either format)
  • Make sure your title page is accurate with a proper title of the project, your name, US University, MSN 563, your faculty name
• Title the first section on page one: Introduction –
  • Restate the CON approved list of subjects
  • Restate your PICOT question
  • Then you MUST give a one to two paragraph discussion of the key terms you used to guide the search for the evidence and the search engines you used to obtain the articles you will discuss.
• Title the next section Critical Analysis of Five Research Articles: all articles have to be within the last 5 years of publication
  • then present summaries of five (5) of the research studies you used to support your project and use the appraisal criteria below to do this part of the paper.
    • Title of the article and the journal
    • Author and Date of publication – has to be within the past 5 years to be used as evidence
    • Type of article published: systematic review, meta-analysis, random clinical trials, cohort studies, etc
    • EBP pyramid level of evidence (Ranks are levels I – VII)
    • Include what was the purpose, process, and outcomes of that research
    • Was the study appropriate and valuable to improve health
    • Who were the participants, how many, was a power analysis done to determine if statistical analysis should be performed
    • Was randomization or volunteer, or specific sample selection used
    • If a systematic review or meta-analysis, how did the authors determine what articles to choose to review?
    • What was the intervention?
    • Were the instruments used to analyze the data valid and reliable
    • What were the results? This includes the stats findings
    • What were the strengths and weaknesses of the published article?
    • This includes the EBP pyramid, the instruments reliability/validity, sample size, type of analysis done, results, limitations, etc
    • Did the strengths or weaknesses predominate and should the article be used to support your project and practice change?
    • Just because it is a level 1 on the EBP pyramid does not mean that it is a quality paper

 Title the next section: Summary of What is Known

• In this section discuss what is known from the evidence you presented and identify any gaps in knowledge from the research evidence you discussed.
• Give a closing statement

References – Cite a minimum of five scholarly references in APA 6th ed format. (7th edition is OK if that is what you have been using). This MUST be in proper APA format.

Attention Wizard Kim. 

Week 6 Discussion: Practicum professional Development Objectives/ Progress Appraisal  3 pages. 

Rubrics 

Reply to this discussion post (site sources if applicable)

In nursing, there are certain specialties in which you might see a disease process more than others. Sepsis, however, knows no speciality. It unfortunately can be found in any area of nursing. Recognizing, notifying and implementing quality care to patients with an admitting, new or suspected diagnosis of sepsis is crucial. Time is tissue with septic patients. They have the capability of going south quickly. Working in the ICU, I believe I have had more septic patients than any other admitting diagnosis. They need interventions implemented within an appropriate time frame to prevent poorer outcomes or death. Lack of communication is a reason why some interventions are not completed or are not fully disclosed leaving the receiving nurse confused as to what is still to be done during sepsis protocols. My project was to implemented a sepsis handoff tool that was to be filled out by nurses to keep up to date on vitals, labs, interventions, blood cultures, fluid resuscitation & vasopressor support, antibiotics as well as the three and six hour bundles. 

A conference I would want to present this information to would be a conference within the Sepsis Alliance Clinical Community (SACC). Each year, SACC holds an annual sepsis conference with national and international speakers. The intention of such conference is to share experiences and evidence on variouds issues related to sepsis. This conference is to improve the awareness and diagnosis of sepsis as well as how to manage it. A journal I would present my topic in would be the “Journal on Quality and Patient Safety” by the Joint Commission. This professional journal focuses on patients safety by implementing quality improvement strategies. It quite often has chapters based off communication, whether using the SBAR technique or handoff tools. 

Please answer the following questions regarding Health Care Costs and Product Differentiation

• Using supply and demand analysis, explain some of the factors that may have led to rising healthcare costs in the United States from 1960 to the present day. In your opinion, which factor has had the greatest impact?
• Discuss the two ways that product differentiation affects the demand for the product. Give an original example of product differentiation.

Must be at least 250 words and two references