Homework answers / question archive / HI215 Reimbursement Methodologies TOPIC #1: Coverage Determinations Medicare Medical Necessity Local Coverage Determinations (LCDs) or local coverage determinations specify under what clinical circumstances a service is covered

HI215 Reimbursement Methodologies TOPIC #1: Coverage Determinations Medicare Medical Necessity Local Coverage Determinations (LCDs) or local coverage determinations specify under what clinical circumstances a service is covered

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HI215 Reimbursement Methodologies

TOPIC #1: Coverage Determinations

Medicare Medical Necessity Local Coverage Determinations (LCDs) or local coverage determinations specify under what clinical circumstances a service is covered.

• Explain medical necessity.
• From the Medicare Coverage Database, access the Local Coverage Determinations (LCDs) Alphabetical Index. Locate and present a procedures/services to determine whether Medicare covers that procedure or service, by scrolling down and clicking on the blue ID to select the procedure (L32553) (the first time might include a License Agreement, go to bottom right and agree, otherwise, when you click the code the information on it will open
• Provide details on why or why not this procedure or service is covered. Scroll through the coverage, the outline will provide details on coverage, limitations, and stipulations. As you review details of coverage note the ICD-10 codes which are deemed medically necessary in support of this procedure.
• What if any stipulations exist of covering these services or procedures
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• HI230: Quality Assurance and Statistics in Health Information
• Topic #2: Incident Reports
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Examine the components of a risk management plan as it relates to incident reporting. Analyze and discuss the pros and cons of storing incident reports in, or acknowledging the presence of them in the patient’s record. Recommend two best practices in regards to storage or acknowledgement of incident reports for the health organization to consider implementing that would limit risk.

Best Practices:

The importance of having a Risk Management Plan is covered in Chapter 11 and incident reports are covered in Chapters 5, 11, and 13 in the Shaw and Carter digital text included as part of this course.

As you consider your response, view the importance of incident reporting and filing of incident reports from a nursing standpoint at the following links:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC46752...

https://www.nso.com/Learning/Artifacts/Articles/Ar...

Respond to the two discussion posts using a minimum of 150-200 words each

Criteria Level III Level II Level I Not Present Criteria 1 Level III Max Points: 4 points Level II Max Points: 3.2 points Level I Max Points: 2.4 points Not Present 0 points Criteria 1: Initial Post Content Quality ? Responds to all parts of the topic(s) with supporting details. ? Responds to all parts of the topic(s). Any of the following are true: No initial post to the topic(s). ? Post includes original thoughts, opinions, or ideas. ? Post includes support from multiple outside sources and/or course materials if required. Criteria 2 Criteria 2: Responses to Others and Engagement in Social Learning ? Post includes original thoughts, opinions, or ideas. ? Post includes support from one outside source and/or course materials if required. ? Does not respond to all parts of the topic(s). ? Post shows no originality when compared to other responses. ? Post does not include outside sources and/or course materials if required. Level III Max Points: 3 points Level II Max Points: 2.4 points Level I Max Points: 1.8 points Not Present 0 points ? Posts two or more responses to others. ? Posts two or more responses to others. Any of the following are true: No responses or ? Does not post at least two responses to others. responses do not follow professionalism and netiquette. ? Two or more responses to others ask follow-up questions or provide additional ideas that expand ? One response to others ask follow-up questions or provide additional ideas that expand on the topic. ? Responses to others do not ask follow-up questions or provide additional ideas Criteria Level III Level II on the topic. Criteria 3 Criteria 3: Post timeliness and length *(applies to DBs with posted length requirements) Level I Not Present that expand on the topic. Level III Max Points: 1.5 points Level II Max Points: 1.2 points Level I Max Points: 0.9 points Not Present 0 points ? Provides an initial post by 11:59 p.m ET on Sunday. ? Provides an initial post by 11:59 p.m ET on Sunday. Any of the following are true: No posts. ? All posts and responses to others meet length requirements (or no length requirement stated). Any of the following are true: ? Provides an initial post after Sunday. ? Initial post does not meet the length requirement. ? None of the posts meet length requirements. ? Responses do not meet length requirements. Criteria 4 Criteria 4: Spelling / Grammar / Formatting / Mechanics Level III Max Points: 1.5 points Level II Max Points: 1.2 points Level I Max Points: 0.9 points Not Present 0 points ? Displays college-level writing in Standard English free of spelling, grammar, or punctuation errors. Any of the following are true: Any of the following are true: No posts. ? Displays college-level writing in Standard English with few spelling, grammar, or punctuation errors. ? Writing includes frequent spelling, grammar, and/or punctuation errors. ? Includes citations when additional sources are used, including title, author, ? Citations are included when additional sources are ? Citations are included when additional sources are used but only include one or Criteria Level III Level II Level I Not Present publication date, and access type (URL, text information, etc). used, but any of the following may be incomplete: title, author, publication date, and access type (URL, text information, etc). two of the following elements: title, author, publication date, and access type (URL, text information, etc). Maximum Total Points 10 8 6 0 Minimum Total Points 8.1 6.1 0.1 0