You are assessing the payer–patient mix for a healthcare organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients.

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Case Study: 

You are assessing the payer–patient mix for a healthcare organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

  • Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).
  • Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).
  • Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.
  • Compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days.
  • Assess the information for areas of improved reimbursement of at least 20% or more.
  • Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.
  • Propose a best strategy with justification and rationale based on effective decision-making tenets.

Soap Note 2 Chronic Conditions

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Soap Note 2 Chronic Conditions

Soap Note 1 Chronic Conditions (15 Points)
Pick any Chronic Disease from Weeks 6-10
Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
 Follow the MRU Soap Note Rubric as a guide

Turn it in Score must be less than 20% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 20%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement

Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions (15 Points)

Pick any Chronic Disease from Weeks 6-10

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Late Assignment Policy

Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions

 

Follow the MRU Soap Note Rubric as a guide:

Grading Rubric

Student______________________________________

This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up.

1)      Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number.

2)      Subjective Data (___30pts.): This is the historical part of the note. It contains the following:

a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts).

b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).

c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner.

3)      Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.

a)      Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).

b)      Pertinent positives and negatives must be documented for each relevant system.

c)        Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts).

4)      Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately.

5)      Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.

6)      Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified.

7)      Clarity of the Write-up(___5pts.): Is it literate, organized and complete?

Comments:

Total Score: ____________                                                          Instructor: __________________________________

Write a 1,000-1,250 word paper examining how the Conceptual – Theoretical – Empirical (CTE) structure translates into nursing practice based on one of the middle range theories that has been formulated or derived from your preferred conceptual model of nursing.

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Topic: Conceptual-Theoretical-Empirical Structure (CTE) Evaluation

Conceptual models, theories, and empirical indicators are linked and provide a nursing knowledge system to apply the model or theory to nursing practice, research, and education. Advanced-practice nurses are required to understand the linkages as applied to nursing and translate the components into practice.  To continue development of nursing knowledge, advanced practice nurses can create structure to test theory.  

General Guidelines: 

Use the following information to ensure successful completion of the assignment:

· Doctoral learners are required to use APA style for their writing assignments. 

· This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

· You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

Write a 1,000-1,250 word paper examining how the Conceptual – Theoretical – Empirical (CTE) structure translates into nursing practice based on one of the middle range theories that has been formulated or derived from your preferred conceptual model of nursing. Translate and apply the selected theory to nursing practice using actual examples. Evaluate the theory using the CTE steps below:

1. Evaluation of the conceptual-theoretical-empirical linkages.

2. Evaluation of the selected theory.

3. Evaluation of the empirical indicators.

4. Evaluation of research findings.

5. Evaluation of the utility and soundness of the practice theory.

Study Materials

1. Philosophies and Theories for Advanced Nursing Practice: chapter 5.

a. URL: http://gcumedia.com/digital-resources/jones-and-bartlett/2013/philosophies-and-theories-for-advanced-nursing-practice-butts-philosophies-and-theories-for-advanced-nursing-practice_ebook_2e.php

2. Evolution of the Mid-Range Theory of Comfort for Outcomes Research

a. Kolcaba, K. (2001). Evolution of the mid-range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92.

b. URL:https://lopes.idm.oclc.org/login?url=http://www.sciencedirect.com.lopes.idm.oclc.org/science/article/pii/S0029655401435986

3. Comparison between Two Nursing Theories: Rogers and Leddy

a. Rahim, L. (2016). Comparison between two nursing theories: Rogers and Leddy. Journal on Nursing, 6(1), 1-5.

b. URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116359098&site=ehost-live&scope=site

4. Middle-Range Nursing Theories are Necessary for the Advancement of the Discipline

a. Fawcett, J. (2005). Middle-range nursing theories are necessary for the advancement of the discipline. Aquichan, 5(1), 32-43.

b. URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=21501730&site=ehost-live&scope=site

5. Review of Research Related to Kristen Swanson’s Middle-Range Theory of Caring

a. Andershed, B., & Olsson, K. (2009). Review of research related to Kristen Swanson’s middle-range theory of caring. Scandinavian Journal of Caring Sciences, 23(3), 598-610.

b. URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=2010378576&site=ehost-live&scope=site

6. Middle Range Theory: Spinning Research and Practice to Create Knowledge for the New Millennium

a. Liehr, P., & Smith, M.J. (1999). Middle range theory: Spinning research and practice to create knowledge for the new millennium. Advances in Nursing Science, 21(4), 81-91.

b. URL:https://lopes.idm.oclc.org/login?url=http://gateway.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00012272-199906000-00011&LSLINK=80&D=ovft

7. Using Data From Critical Care Nurses to Validate Swanson’s Phenomenological Derived Middle Range Caring Theory

a. Hanson, M. (2004). Using data from critical care nurses to validate Swanson’s phenomenological derived middle range caring theory. Journal of Theory Construction and Testing, 8(1), 21-25.

b. URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=2004183925&site=ehost-live&scope=site

8. Caring Model: Putting Research into Practice

a. Amendolair, D. (2012). Caring model: Putting research into practice. International Journal for Human Caring, 16(4), 14-21.

b. URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=2011906158&site=ehost-live&scope=site

9. Marie-Luise Friedmann. (n.d.). Florida International University [Faculty web page].

a. This website provides information on the Framework of Systemic Organization Treatment Model.

b. URL: http://faculty.fiu.edu/~friedemm/

10. Conceptual Framework for Comfort Theory

a. Conceptual framework for comfort theory. (n.d.). The Comfort Line.

b. This website provides information on comfort theory.

c. URL: http://www.thecomfortline.com/home/intro.html

Describe what is suggested as to company policies in the last paragraph entitled Implications for Managers on page 17 in the Management Perspective – “Marriage Equality and the Constitution”.

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A. On page 17, in the Management Perspective entitled “Marriage Equality and the Constitution”, what is the issue that is being covered?
B. What did Congress attempt to do in the federal law known as DOMA that is mentioned on page 17? How did the federal courts rule on DOMA when it was challenged?
C. Do some research and find out how the U.S. Supreme Court ruled in the 2015 case known as OBERGEFELL ET AL. v. HODGES, DIRECTOR, OHIO DEPARTMENT OF HEALTH, ET AL. involving same-sex marriages.
D. If you were on the U.S. Supreme Court, how would you rule in a same-sex marriage lawsuit against a state that does not recognize them? Be sure to state the legal reasons behind your opinion.
E. Describe what is suggested as to company policies in the last paragraph entitled Implications for Managers on page 17 in the Management Perspective – “Marriage Equality and the Constitution”.