93306- Echocardiography, transthoracic, real-time with image documentation (2D) with Doppler. Payment was denied due to the lack of medical necessity for the frequency of the billed procedure. The carrier stated that the procedure was last performed on August 28, 2014. There was no documentation dated after the procedure performed on August 28, 2014, or before the date of service billed in this appeal. The medical documentation did not highlight acute symptoms warranting the need for the service in question. There was no documentation of symptoms or physical findings that would support the performance of the service in accordance with Medicare guidelines. The beneficiary was an 87 year old woman. She went to the doctor “… for the
The language arts have always been an impactful part of my education. I always find myself enjoying these classes, but I know they’ve always felt easy. They’ve never been challenging enough. College is an intimidating factor I’ve yet to face. I feel as though I should learn what is necessary to further my education and push myself to the limits that I won’t reach if I’m to continue on with the current English classes. I understand that it will be significantly more difficult than English 11 and I acknowledge the work I will receive if I am to take College Prep.
Write a summary review of Appendix A, B, C, and D from Intelligence Led Policing "The New Architecture" from Week 5.
I have learned many very important skills from BPBE 272 that I value in my educational career as well as in my future endeavours. Yes, I learned all of the key elements of economics that makes it so important in the world today, but most importantly I learned how to apply all of the economic skills BPBE 272 gave me. This class gifted me with the ability to evaluate the world around me and within my career in an economic mind set. This class really enforced a life long understanding of agricultural economics through the use of teaching styles that require us not to memorize, but to actually learn and hold the information. Throughout, I will explain:
The reason we want to capitalise the lease commitments is that reporting under operating assets leads to substantial amounts of off-balance-sheet assets and liabilities. Hence, it is difficult to compare financial statements between two similar companies but use different accounting methods for essentially the same transaction.
Social workers have a history and tend on treating problems with their clients, but due to budget cuts and changes in policy, social workers are focusing their attention on preventing the problem. Bush (2000) stated that
Fictitious reductions of expenses improve the bottom line on financial statements and can mask true losses and debt. (Crumbley, Heitger and Smith, 2013). An airline has a large fleet of aircraft that require extensive routine maintenance costs. In times of unprofitability, the airline might improve earnings by recording additional upgrades to planes as expenses by deferring losses to future periods. GAAP section 39.200 provides details around how capital assets should be recorded on the balance sheet and the associated depreciation should be recorded (GAAP, 2015).
Based upon the information provided, it has been determined that: the requested admission/day(s) is not/or are no longer medically necessary because: After review of the clinical information provided by North Shore University Hospital -Manhasset, the Medical Director has denied your admission to North Shore University Hospital - Manhasset. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 58 year old male, with a pre-authorized outpatient procedure on 09/02/2015 for a cardiac catheterization with an intervention, which was converted to an inpatient level of care. Based on the Interqual criteria (a decision based program to determine medical necessity) this procedure does not require an inpatient level of care, therefore, it does not meet criteria.
The record submitted was insufficient and did not contain the required documentation to establish the medical necessity of the service billed.
This goes back to the feedback you were given on the last Complete section which you had questions about. Let me try to address that feedback while giving you examples from your work here. Please note that you have to cite research whether you paraphrase it or quote it directly. The sole differences are that 1) The direct quote goes in quote marks; paraphrased research does not, and 2) That you do not cite with page or paragraph info when you paraphrase. I think what my previous feedback indicated was this: Research use is great. However, I would far prefer few direct quotes. In other words, paraphrase your research rather than quoting directly. Direct quotes should be used extremely sparingly. There
The carrier has denied coverage of FDG-PET scan as not medically necessary. A letter from the carrier to the member, dated 05/08/2016, states in part:
Appointment Cancellation and No-Show Policy for All Patients. We ask that you give us at least 24 hours’ notice if you will be unable to keep an appointment you have scheduled. We may try to use that appointment for another individual seeking assistance from our clinic. If you provide us with less than 24 hours’ notice, we will designate the appointment as a “no-show.” Your provider may speak to you about your commitment to treatment if you have too many “no-shows.” If you do not reschedule at the time of cancellation, a staff member will contact you and offer a follow-up appointment.
Sonja is seriously injured in an auto accident. After six months, she is still unable to return to work. She has no income from her job, and the insurance premium payments are financially burdensome. In this case Sonja has an ordinary life insurance with the waiver-of-premium attached so after six months all premiums would be waived if Sonja is totally disabled. Under some policies, a retroactive refund of the premium paid during the first six months would be paid. (Rejda, George, McNamara, 2014).
Summarize the employment-at-will doctrine discussed in the text and then evaluate three (3) of the six (6) scenarios described by determining:
The doctor’s note indicated that the beneficiary was evaluated for a chronic medical condition. The documentation submitted did not support the need for weekly evaluation and management; there was no indication of any new significant medical issues that would necessitate the increased frequency of the service.
The carrier has denied coverage of the PET scan as not medically necessary. There is a letter from the carrier to the member dated 02012016, which states in part: