Category: Nursing

Billing and Reimbursements Essay

For this unit assignment, please respond to the following key activities related to billing and reimbursements. The information for these activities can be found in Chapter 7 of your textbook.

Briefly describe the reimbursement methodologies.

Select a payment system, discuss your selected payment system, and identify its role related to billing and

reimbursement.

Discuss why a claim may be rejected and possible ways to prevent a claim from being rejected.

Your response should be at least two pages in length, not including the title and reference pages.

The purpose of this assignment is to allow you to recognize the policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, and managed care.

Assignment Combining Nurse Leader with Advocacy

Rate yourself using the results from the “Nurse Manager Skills Inventory”:

http://www.aone.org/resources/nurse-manager-skills-inventory.pdf

Write a reflection of 750-1,000 words in which you identify your strengths and weaknesses related to the four content areas below:

Personal and professional accountability

Career planning

Personal journey disciplines

Reflective practice reference behaviors/tenets

Discuss how you will use your current leadership skill set to advocate for change in your workplace.

Identify one personal goal for your leadership growth and discuss your implementation plan to achieve that goal.

While APA format is not required for the body of this assignment Combining Nurse Leader with Advocacy, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment Combining Nurse Leader with Advocacy 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 Combining Nurse Leader with Advocacy to Turnitin. Please refer to the directions in the Student Success Cent

HEENT Case Study

L. Albert, a 25- year-old college student, is in your clinic because of sore throat. 7 days ago, he developed fever which was low (99 F) to moderate grade (101.1 F). This was associated with swollen and tender neck glands. He has sore throat but denies having cough. He has no abdominal pain but feels as if his upper abdomen has become swollen and he has lost his appetite. He has no nausea, vomiting or change in bowel movements. Since yesterday, he has noticed that his eyes and skin have turned a yellow color. He has no past medical history of jaundice, hepatitis, blood transfusion, body piercing, tattoos or eating shellfish. He does not drink, smoke cigarettes, or use illicit drugs. He doesn’t take any medications. He hasn’t traveled recently. He is sexually active and is in a monogamous relationship with his girlfriend of 2 years who is experiencing similar symptoms. He is heterosexual and has had two previous sexual partners. He always used condoms. He received Hepatitis B vaccination prior to starting college.

PPE: Patient is well-developed, in no acute distress. He appears concerned and anxious.

VS: BP – 130/80, PR- 110/min, RR – 20/min, T – 101.4 F, SpO2 – 99%.

HEENT: PERRLA, EOMI, icteric sclerae, pink conjunctivae, Tonsillo-pharyngeal area erythematous with exudate.

Neck: posterior cervical lymph nodes swollen, tender and movable, bilaterally. Supraclavicular lymph nodes not enlarged.Heart and lungs:

Normal abdomen: Normal bowel sounds, liver – 14 cm in midclavicular line by percussion, diffuse tenderness over both right and left upper quadrants on palpation.Neurological exam: no deficits.

Overview

In 1–2 pages, define and outline a measurement strategy to be used to measure the effectiveness of an OIP.

Note:
You must complete Assessments 1, 2, and 3 before you can begin this assessment.

By successfully completing this assessment, you will demonstrate proficiency in the following course competencies and assessment criteria:

Competency 2: Apply theories, models, and practices of global operations management to address business problems.

Explain two measures to be used to gage the effectiveness of process improvements.

Describe how two measurements define and quantify the outcomes of an improved process

Competency 3: Integrate operations management analyses into general business management planning and decision making.

Outline a measurement strategy to be implemented with an operations improvement plan.

Competency 4: Communicate in a manner that is professional and consistent with expectations for members of the business professions.

Communicate in a manner that is professional and consistent with expectations for members of the business professions.

Context

Operating a business, particularly one that is growing rapidly, requires a careful balancing of production and service capacity and a consideration of human resources, capital, inventory, and tracking systems. Balancing the capabilities of these resources can be challenging and is achieved through proper planning techniques and management. Planning entails the use of appropriate forecasting tools and techniques that can provide an accurate estimate of future activity.

What can organizations that depend on uncertain conditions (weather, customer demands, and currency fluctuations, among others) do to minimize downtime and loss of customer goodwill? What would happen to NASA, the New York Yankees, and the airline industry—all organizations that depend on such predictions for their financial well-being—if they could not predict favorable operating conditions? The ramifications would be negative, of course. But the application of sound forecasting and measurement techniques can minimize the likelihood of those negative consequences. In recent years, there has been a proliferation of software programs for forecasting and measurement. You may want to take some time to research online the kinds of resources now available for businesses of all sizes.

Questions to Consider

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

What are the advantages and disadvantages—to the organization and to the consumer—of incremental expansion when aiming to grow capacity? What are the advantages and disadvantages of one-step expansion?

Deming (1987) states that one of the seven deadly diseases is presenting only visible figures as input for organizational leaders.

How do you think this concept could affect your selection of data and measurement strategies?

When historical data are not available and the product or service is new, how would you arrive at a reasonable forecast?

How does this concept relate to your job or personal experience?

Reference

Deming, W. E. (1987). Transformation of today’s management.
Executive Excellence, 4
(12), 8.

Resources

Suggested Resources

Toyota Specific Resources

Gerondeau (2015). How Toyota Recovered from a Huge Crisis. What can be learned from it. Retrieved from: https://thethirdroad.com/?p=280

Khan, Riz (2010). The Toyota Crisis. Al Jazeera English. Retrieved from https://www.youtube.com/watch?v=EDRFamLGATk

Toyota Motor Corporation. (n.d.). The origin of the Toyota production system. Retrieved from http://www.toyota-global.com/company/vision_philosophy/toyota_production_system/origin_of_the_toyota_production_system.html

Trudell, Craig and Yuki Hagiwara (2014). Toyota Recalls More Than 6 Million Vehicles Worldwide. Retrieved from: http://www.bloomberg.com/news/articles/2014-04-09/toyota-recalls-6-76-million-vehicles-worldwide-including-rav4

Additional Resources for Further Exploration

You may use the following optional resources to further explore the Questions to Consider and assessment topics.

Operations Management

The following resources offer a foundational broad view of operations management.

Deming, W. E. (1987, December). Transformation of today’s management. Executive Excellence, 4(12), 8.

Foster, S. T., Wallin, C., & Ogden, J. (2011). Towards a better understanding of supply chain quality management practices. International Journal of Production Research, 49(8), 2285–2300.

You may want to search this blog for the following terms: automotive recalls, operations improvement, and strategic planning.

Harvard Business Publishing. (n.d.). HBR blog network. Retrieved from https://hbrblogs.wordpress.com/

Imanipour, N., Rahimi, M., & Akhondi, N. (2012). An empirical research on supplier relationship management in automotive industry. International Journal of Business and Management, 7(9), 85–95.

Jeang, A. (2010). Optimal process capability analysis for process design. International Journal of Production Research, 48(4), 957– 989.

Beers, Hamerman, Cohen, & Burger. (2015). Managing Your Business through a Crisis: 6 Steps to Success. Retrieved from: http://bhcbcpa.com/managing-your-business-through-a-crisis-6-steps-to-success/

Value Creation Partners. (n.d.). Analyzing and improving operations. Retrieved from http://www.valuecreationpartners.com/training/analyzing-and-improving-operations/

van der Aalst, W. M. P. (2011). Process mining: Discovery, conformance and enhancement of business processes. New York, NY: Springer. Available from the bookstore

Wagner, S. M., Jönke, R., & Eisingerich, A. B. (2012). A strategic framework for spare parts logistics. California Management Review, 54(4), 69–92.

Case Studies

The following case study is recommended for further examination of the topics addressed in this assessment. You may wish to purchase it from Thunderbird School of Global Management.

Inkpen, A. C. (2011). Southwest Airlines 2011 [Case No. A10-11-0003]. Glendale, AZ: Thunderbird School of Global Management.

Assessment Instructions

Note:
You must complete Assessments 1–3 before beginning this assessment.

As part of your OIP, you will need to propose a measurement strategy. This strategy will be used to measure the effectiveness of the new process you are proposing for use in the Toyota Motor Company circa 2010. Different measurement strategies will define and quantify outcomes in different ways, so you want to be intentional about selecting the right way to measure the efficiencies gained through your improvements.

Preparation

Begin your work by researching potential ways to measure the specific process that is the focus of your OIP. Consult the Resources and conduct your own research in the Capella University Library and online. Be sure to consider both qualitative and quantitative measurements. As you do so, consider the following about the measurement strategies you review:

What are they measuring?

What does improvement look like according to that measurement?

What kind of information and data is needed to effectively employ that measurement?

Instructions

Craft a report detailing the measures you will use to gage the effectiveness of your OIP and your overall strategy for implementing those measures. Your report should include the following:

An explanation of two quantitative and/or qualitative measures you will employ in your measurement strategy and why you selected them for your particular OIP.

A brief description of how each measurement will define and quantify the outcomes of your proposed improvements.

An outline of your proposed measurement strategy for gaging the effectiveness of your OIP. Be sure to include how and when you will gather the data necessary for making these measures. Your measurement strategy should combine and order your selected measures in a meaningful way in order to help you understand the impact of your OIP. In your overall strategy, be sure to address how your measurement strategy will help you determine if the results of your OIP are positive, help you ensure that your process does not have an unanticipated negative impact elsewhere, and help you assess if further process change is needed.

Note:
Please review and update cause-and-effect diagram and process flowchart in each assessment.

The work you do for this report should inform your work in future assessments. You will also draw on it for the final, comprehensive OIP that you will submit in Assessment 6.

Additional Requirements

Length of report:
2–3 typed, double-spaced pages.

APA formatting:
Format resources and citations according to APA style and formatting.

Font and font size:
Times New Roman, 12 point.

Recruiting Plan

Assume your learning team is the hiring manager.  Pick an entry level or supervisory position in healthcare or HR (for example a home health aide, a patient services representative, an HR representative) and prepare a detailed recruiting plan, of approximately 1,000 – 1,250 words, to hire for that position.

The plan should be written so that you could submit it to your manager and HR for approval, but is must also include the educational support (description of concepts with citations).  Include:

Describe how you would conduct a job analysis to confirm the duties and responsibilities of the job.

Prepare a summary of the job description including the essential functions and job specifications.

Advertising – where and why will you post/advertise the job.

Screening – criteria that you will use to review resumes and determine who to interview.

Interviewing – who (by position) will interview and areas they will cover.

Selection process – how will you make a final choice?

Do the paper in APA format (cover page, headings, reference page) but first person is fine.  Cite the educational resources that you use to support your plan.

The recruitment matrix is not required for this assignment.

Grading Rubric Week 3 – Recruiting Plan

Points

Description of Job Analysis process

1

A summary of the job description including essential tasks and job specifications

1

Recruiting Plan

Advertising – where and why

Screening – criteria and process for determining who you will interview

Interviewing – who (by position) will interview and areas they will cover

Selection process – how will you make a final choice?

 

1

1

1.5

1.5

Appropriate research – minimum of 2 – and use throughout the paper

2

Adherence to UOP standards for written work

APA format

Major points are organized in a logical fashion.  Each paragraph is clear and contains one major idea.

Rules of grammar and punctuation are followed.

No spelling errors

Word count approximately 1,000-1,250 words.

1

Total Points

10.0

Physician’s Practice Management: “Group Medical Practices in the U.S

According to the textbook, a comparison of several countries with different levels of income shows that quality of healthcare and life expectancy among these nations are similar. However, the cost of care in the U.S. is the highest among the nations in the comparison. Analyze the main specific factors that affect the cost of healthcare services in the U.S. and recommend one (1) way that physician practices can help reduce the overall cost of healthcare services in the U.S. Provide a rationale for your response.

2. Assess the key different types of physician practices and evaluate three (3) administrative challenges that practice administrators face in providing quality services to the communities they serve. Support your analysis with specific examples.

Challenges for Group Practice Administrators and Recruitment Strategy for Practice Managers

Predict two (2) external and / or internal challenges facing today’s medical group practice administrators. Compose a strategy to manage the challenges in question. Justify your response. Imagine that you work for a medium-sized healthcare organization and the organization is hiring a medical practice manager. Determine three (3) areas of competency that you think are most important to effectively manage a medical group practice. Next, suggest a recruitment strategy that includes the method you would use to advertise the position and the information you would include in the job posting to attract qualified candidates. Justify your response.

Aspects of Human Resources Management and Marketing Strategies

Appraise the key functions of Human Resources Management (HRM) and state your opinion as to whether or not HRM should be part of the strategic planning process for medical group practices. Support your rationale with specific examples.

Evaluate the importance of effective marketing for medical practices. Recommend three (3) specific factors that a practice administrator should consider when creating a marketing plan for a medical group practice. Justify your recommendations.

The Application of the Saul Alinsky

The Industrial Areas Foundation of Saul Alinsky has been referred to numerously in community organization.  Review the Saul Alinsky, Community Organizing and Rules for Radicals article, research the roots of this method, and then discuss its application of “the ends justify the means” in today’s economy.  Address whether this theory is still applicable.  Why or why not?  Under what circumstances?  Provide a specific example to illustrate your perspective.  Prepare a two- to- three page paper (excluding title and reference pages) with a minimum of two scholarly, peer-reviewed sources that were published within the last five years, in APA format.

Designing and Implementing an Effective Compliance Plan

The Office of Inspector General (OIG) has established a set of guidelines (e.g., auditing, monitoring, internal controls, sampling, due diligence, and standards of organizational and employee behavior, etc. Page 508 of the textbook) that physician practices should follow when creating a compliance plan. State your opinion as to which OIG guideline would be the single most significant aspect of a compliance plan for a small practice. Provide a rationale for your response. According the text, the fundamental purpose of a compliance plan is to create an organizational culture that promotes the prevention, identification, and resolution of issues associated with risk. Suggest two (2) main aspects of a management strategy necessary to create this type of culture. Support your recommendations with at least one (1) real-world example.