Some key points I was able to take away from today’s class time were the following: 1. There are two types of therapy billing codes, these being timed or untimed. Untimed codes are flat rate; this means that these codes are reported as one unit per day regardless of the amount of time spent with the client. Timed codes are reported using the 8-minute rule. 2. The 8-minute rule is a bit more complex when it comes to billing timed codes. First, one must add up the total treatment time for the timed codes, excluding the time spent on untimed codes. The next step consists of taking the total treatment time for the timed codes and looking at the minute rule chart to determine the maximum number of units one is able to bill. 3. If one is in a
situation where one has provided more timed services than one can bill for, then one should bill the appropriate number of units for the services in which a skilled service was provided. One’s documentation should support the units being billed at all times.
were paid piece rates so if any problems did occur such as a drop in
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
Case 1 -- You work in a busy multi-specialty clinic with a high patient volume. The physicians enter the type of code that will yield the greatest reimbursement. You suspect the codes are not accurate.
Conversely the OPPS (outpatient prospective payment system) is controlled for different service groups such as the APCs (ambulatory payment classifications). The outpatient services in the various APCs are the same in terms of the required resources and clinical aspects. The payment rate for APC for each group is adjusted to justify the geographic differences and is applied to all of the services in this group. The health care institutions adopt a fixed amount for all the outpatient service based on the classifications of the ambulatory services. Marcinko (2006) notes that Medicare uses it to reimburse the health care providers for the items and serves which are not part of the prospective payment systems. A MPFS (Medicare physician fee schedule) determines the rate of payments for therapy and physician services based on conversion factors, relative value units, as well as, the indices costs.
Medical billers often communicate with physicians and other health care professionals to explain diagnoses or to attain further information by means of phones, email, fax, etc. The biller must know how to read a medical record and be familiar with CPT®, HCPCS Level II and ICD-9-CM codes.
Case conceptualization and treatment planning is used by therapist to assist in determining a client’s diagnosis, goals, and treatment plan that is most effective in determining the issues surrounding the clients diagnosis. It is crucial that the client’s treatment plan is specific to the individual, is relational and appropriate to the needs of the client.
Being a course about leadership, I was able to learn several takeaways important to being a leader.
The first learning outcome in which I would like to discuss is writing. Writing effectively for rhetorical situations while working on my discourse community paper about Kappa Delta Sorority is perhaps one of the areas I found myself struggling the most in. This is because I consistently got stuck when making sure the paper had a logical flow within each paragraph and keeping
The concepts I have learned about throughout the first half of this class have been interesting, some more than others. There are five that are the most meaningful to me. They are global perspective, culture, society, peer group, and reference group.
Over the course of this class I have pieced together many things about my own life that before went unnoticed. I am now able to see things in a bit of a different light. Now that I have been introduced to the realm of psychology I understand some of the reasons for behavior around me. I have learned that there is a reason for most everything and a lot of our behaviors and mental processes can be explained through psychology. Studies have been conducted for many years to try and pinpoint the source of our behavior and it is not something that most people think about every day. Having a better understanding of why we operate the way we do will help me to better understand myself and the others around me.
In this class, I was able to look deeper into problems that are occurring around me but also globally. There are so many global issues that
1. Considering the numerous points that were made in the course, make a List of at least five concepts (questions to ask myself as I counseled those who are suffering...") that you found particularly helpful, insightful, unique, or had not thought about before.
Out of everything that we 've learned this quarter, goal setting was something that stood out to me. There are a few times where I set a goal in my head but end up never achieving them, wether it was something very simple or more of a long term goal. A technique that stood out to me in our notes is, writing down your goals. I don 't I 've ever written down a single goal that I 've had. In class and in our notes we talked about how it is important to write down your goals and how you cannot just write the general idea of your goal, but how you need to be very specific in what it is you want to achieve. I think that in college it 's very important to set long, mid, and short term goals because somedays will be harder than others and you need
Lastly, I gained a greater knowledge covering the seventh outcome of the class: Express an understanding of, and exhibit respect for, diversity in human sexuality. Before I took this class, I had generalized asexual people as being lonely or depressing people whose sexual behavior were a result of previously having a hard time building relationships. After hearing the perspectives asexual people had in lecture and from reading chapters in the book, I gained a much better understanding of the difference in human sexuality asexual people hold compared to me. I learned throughout the course of the class that humans don’t necessarily have a default sexual orientation, and that gender was a spectrum, not a generalized standard, and that helped me come to understand and respect the amount of diversity human sexuality has from person to person. Some examples that had the largest impact where seeing videos in class covering transgender persons and their outlook and struggles with the process, and the research Kinsey did on sexual orientation with his Continuum of Sexuality on a scale from 0 to 6. This outcome stood out to me the most, because it’s the one that I recall often in my day to day life
Some of the examples that I have learned in this class are that the more I have nature around me; I live a healthy life. I also learned that taking some time off your work and enjoying a quality time in the nature would reduce my stress and lead me to a better job performance. One of the experiences that I did for this class is, I went to the County Memorial park a few weeks ago with my friends to spend some time together and enjoy the nice weather. We prepared to cook a delicious barbecue so, I went out to buy what we need for the barbecue. The weather was so nice: warm and cloudy. We went to the park at 1:00 pm and we left at 5:00 pm. We choose a cabinet close to the water (lake). The place was so quiet. We can hear the sound of the water and we can see the birds flying and moving around. This experience reminded me of the times I had with my family back home. We used to go to the park all the time. It was one these times that you never think of anything but enjoying the moment. We finished eating, then, we started relaxing and taking pictures of the nature around us; from the tree to the water over the flying birds. We had an amazing time. We stayed there all afternoon. I was inspired by the view of the sunset reflecting on the water and the breeze that sways trees and the winds that blow your mind away. It was without any doubt time well invested. It gave me the relaxation and the energy I needed to do