National Practitioner Data Bank (NPDB)
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Kaiser Permanente has been equipped since 2007 with Health Connect; which is the largest private electronic health record implementation in the world. This is a highly sophisticated electronic program that integrates inpatient, outpatient, and clinic medical records with appointments, registration, pharmacy, and billing for all kaiser members. In addition, this electronic program includes an entire medical library with a whole set of care support tools which are accessible to doctors, nursing staff and patients (Kaiser Permanente, n.d.). At kaiser permanente; nurses are expected to print out “the after-visit summary” (AVS), which contain the doctor recommendations for each patient that we see.
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According to the US department of health services the most common HIPAA violation in hospitals is the impermissible uses and disclosures of protected health information. A prevalent scenario is when a health care worker accesses files of patients who are not under the worker’s care. Anyone that is not directly related to the patients’ health care or insurance is not allowed to access the patients’ health records. This can be prevented by having all employees participate in HIPPA training after a direct violation of the policy along with mandatory training before their employment. Another preventive measure is informing workers, upon employment, that electronic medical records indirectly allow for monitoring the use and misuse of patient files.
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Their mission is “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value”, (Joint Commission, 2014). The accreditation from the Joint Commission can be earned by multiple health care organizations including critical access hospitals, office based surgery centers, behavioral health care facilities, and home care services. For a hospital setting, the Joint Commission places the performance measures into accountability and non-accountability measures. They look at research and if the facility is performing evidence-based care process which improves health outcomes, proximity which the care process is linked to the patient outcomes, accuracy for whether or not the care process has indeed been provided, and any adverse effects. To earn and maintain The Joint Commission’s Gold Seal of Approval™, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years (Joint Commission,
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Emergency and ambulatory care is one of the largest-volume patient activities, which makes it a key point of the continuum of health services in Canada. To better understand how this component of care is formed and shifting, several databases are managed to provide stakeholders with insight on visits, patient demographics and clinical, administrative and service-specific data associated with day surgery, emergency departments and outpatient clinics. These databases are fundamental components in carrying out the mandate to deliver unbiased, quality, reliable and relevant information to support decision-making and inform health care discussions. One of these core databases is National Ambulatory Care Reporting System (NACRS). The NACRS is a
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ARNPs in Washington State are responsible for continuously and comprehensively managing a wide range of patient care concerns and problems (Phillips, 2024). ARNPs are legally authorized to serve as Primary Care Providers (PCPs), admit patients to hospitals, and hold hospital privileges. However, credentialing decisions are at the discretion of hospitals and medical staff (Phillips, 2024). APRN in Washington State Florida Vs. Washington state practice Key legal, regulatory, and credentialing issues facing APRNs Scope of Practice Restrictions: APRNs face varying state regulations that limit their ability to practice independently, hindering their full utilization of skills (Buck, 2021) Credentialing and Certification Requirements: APRNs must meet stringent certification criteria, but changes and variations across states challenge maintaining credentials (Buck, 2021).
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With ICD-9 in place now in the health care industry there is a huge volume of fraud being committed in the coding and billing department. Patients are being over charged for procedures that cost half the price, or charged for procedures that were never performed on them. This is costing health insurance companies
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is a privately run home healthcare agency. Our company is operating in several locations in ten states, to date with over 40 agencies. We take confidentiality very seriously throughout all the departments of the company, making sure that the staff is aware of the policies and procedures that are put in place for assurance of our patients’ privacy. As I stated in my previous homework assignment, there are several departments within AngMar that handle different aspects of the healthcare process having the possibility of seeing patient information and there are compliance procedures set in place that are mandated by the company and the state in order to prevent any employees from sharing anyone’s private information. We work closely with Medicare and Medicaid in order to serve our patients, who are usually under a physician’s plan of care and need skilled nurses to assist them in their home (About Us, n.d.).
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As records were shared electronically rules were implemented for clinicians to follow known as The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Summary of the HIPAA Security Rule ,2013). These rules were implemented for clinicians to protect the
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However, many barriers are still exist in their practice such as, state practice and licensure, physician related issues, payer policies and restricted prescriptive privileges. The APRN practice is regulated by state licensure, only one third of the nation has adopted full practice authority licensure and practice laws for APN. Variation in scope of practice across states has a direct impact on patient care as the supervision of physician may affect opportunities and payer policies of APN. Consequently, it is important to have full practice authority for APNS to reduce these barriers. Many physician professional organizations still believe that APNs are incapable of providing quality and safe care at the physician’s level.
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For every 2 dollars billed from a doctor’s office, hospital, chiropractors, a dollar of that is fraud. Hospitals, doctor’s offices, skillfully unpacked the diagnoses to make the most money for each patient treated. But, DRGs did have a effect on hospitals that was noticeable to the employee’s and facility, patient length of stay was decreased, the longer the patient stay, the more it cost the hospital and then it was paid on a fixed rate and Medicare used a resource-based relative value scale, which base the physician payments. Not only is there Medicare fraud from medical workers and facilities, it also comes from the patients as well.
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Reimbursement Reimbursement for services may differ for NPs depending on the restriction of services they can provide as outlined by their state’s practice laws (Kaiser Family Foundation, 2011). Credentialing and payment that is managed by many health plans provide payment according to the services that an NP can provide in each state, or from a federal perspective, Medicare will only pay 85% of the full physician rate to a billing NP or Physicians’ Assistant (PA). This is because the laws are not unified throughout all 50 states (Cassidy, 2012). Many NPs do not feel that this payment model it fair for several reasons (S. S. Gordner, personal communication, July 13, 2016).
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What is a Health Information Specialist? Health information specialist is a blanket term that is applied to a variety of technical positions. Almost all of these jobs involve medical data, information technology, electronic health records and health information management systems. The BLS states that the job outlook for health information technicians is expected to continue growing at 15 percent, which is much faster than average.
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Medicinal Doctor Protection operators/organization
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The ability to use various resources is an important aspect of providing safe care, while simultaneously basing the care on an evidence based practice. In this regard, it allows the student FNP to become confident in making decisions in the interest of the patient. This is a great learning experience to carry forth in the subsequent courses. As we continue to build the necessary knowledge base, there will be times of frustration that will get translated into success. In this class, we had the opportunity to gain value information that has provided a substantial foundation as an FNP.
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Professional Experience: 1-Clinical clerkship in the Eastchester Nursing home in Bronx, NYC : May 2015- present and December 2014-April 2015: working under supervision of Nursing home Director Dr Mortazavi,got introduced to EMR(electronic medical record), responsible for acquiring a complete history and physical exam as well as charting the patients required plan in management, involved performing routine in-patient follow up, admission note and discharge summaries. 2-Family medicine hands-on clinical rotation in DeTar Hospital Navaroo,Victoria,TX April 25,2015-May17,2015 .Working under the supervision of Program Director Dr Ontai and Dr Nwanegbo. My day-to-day tasks included taking medical history, doing a physical examination,
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