Health Medical Homework Help

HI215 Reimbursement Methodologies

TOPIC #1: Coverage Determinations

Medicare Medical Necessity Local Coverage Determinations (LCDs) or local coverage determinations specify under what clinical circumstances a service is covered.

• Explain medical necessity.
• From the Medicare Coverage Database, access the Local Coverage Determinations (LCDs) Alphabetical Index. Locate and present a procedures/services to determine whether Medicare covers that procedure or service, by scrolling down and clicking on the blue ID to select the procedure (L32553) (the first time might include a License Agreement, go to bottom right and agree, otherwise, when you click the code the information on it will open
• Provide details on why or why not this procedure or service is covered. Scroll through the coverage, the outline will provide details on coverage, limitations, and stipulations. As you review details of coverage note the ICD-10 codes which are deemed medically necessary in support of this procedure.
• What if any stipulations exist of covering these services or procedures

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• HI230: Quality Assurance and Statistics in Health Information
• Topic #2: Incident Reports
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Examine the components of a risk management plan as it relates to incident reporting. Analyze and discuss the pros and cons of storing incident reports in, or acknowledging the presence of them in the patient’s record. Recommend two best practices in regards to storage or acknowledgement of incident reports for the health organization to consider implementing that would limit risk.

Best Practices:

The importance of having a Risk Management Plan is covered in Chapter 11 and incident reports are covered in Chapters 5, 11, and 13 in the Shaw and Carter digital text included as part of this course.

As you consider your response, view the importance of incident reporting and filing of incident reports from a nursing standpoint at the following links:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC46752…

https://www.nso.com/Learning/Artifacts/Articles/Ar…

Respond to the two discussion posts using a minimum of 150-200 words each