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ED is diagnosed with MI, no error is held accountable for her decisionVeracity- obligation to present information honestly and trustfully, in order for patient to make informed decision, do not withhold “bad news”, Ex. Patients mammogram results are in, but son does not want patient to know, no must tell patientPaternalism- one person interferes or overrules the autonomy of anotherOmbudsman- person who acts as intermediary between patient and organization, ombudsman investigates and mediates complaint form both sides and attempts to reach fair conclusionGuardian ad litem- person assigned by court to act in best interest of the child/frail vulnerable patient.TPA- organization that does processing of claims and administrative paperwork for another companyMedicare A pays for inpatient services, (Hospice)
Medicare B pays for outpatient services (ambulance emergency only)Medicare C pays for bothMedicare D is for medications drug benefitMedicaid -provides insurance for low income individuals and families who meet poverty criteriaHMO-patients assigned PCPC (gatekeeper),copay per visit, PCP must approve referralPPO-not assigned PCP, can visit any PCP, more expensive than HMOMedicare B does not reimburse for dentures glasses or hearing aids or ambulance transportationCOBRA-is law that allows person to keep insurance after quit jobMedical home- primary healthcare delivery of PT/OT/speech, communicate thru phone, video chat or email.PROFESSIONAL ROLES AND REIMBURSEMENTState nurse practice act – “right to practe”enacted into law by state legislatureState board of nursing- responsible for forcing state nurse practice actTitle protection- titles protected by lawStandard of profession nursing practice- developed by professional societiesCollaborative practice agreements- written agreement between supervising physician and NPSituational leadership- flexible, can adjust his or her leadership styleTransformational leadership- ability to communicate vision to staffLaissez-Faire Leadership- minimal supervision or direction of staffAuthoritarian Leadership- like control and structureDemocratic leadership- likes more staff meeting for input from staffServant leadership- likes to work along staffMalpractice- duty is owed, duty was breached, breach caused injury, damage occurredProblem focus visit- chief complaint, HPI, no ROS or past family/social history neededNPI- contains 10 numbers/digitsICD 10 code- diagnosis codesCPT codes bill outpatient office procedures and servicesIncident to – billing is used for Medicare patients and refers to billing follow up visit performed by non-physician provider billed under physicians NPI#, nonphysican is paid 100% vs the rate of an NP who receives 85%Insurance- considered third party