Ethical Practices in Accounting

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Ethical Practices in Accounting

(Ethical Practices in Accounting)

How do accountants stay ethical

First, reflect on how ethics (i.e., acting with intentional integrity) fits into the topics covered in this course. For example, consider how accountants stay ethical in their job or how respect for the profession maintains an accountant’s ethical conscience. What is your plan for making sure you remain an ethical accountant?

Ethical Practices

 

Ethics, particularly acting with intentional integrity, is a foundational aspect of accounting. Accountants are responsible for handling financial information with honesty, accuracy, and transparency, which directly impacts businesses, stakeholders, and the broader economy. Ethical considerations in accounting include adhering to principles such as objectivity, confidentiality, professional competence, and due care.

One way accountants maintain ethical standards is by following established guidelines like the Generally Accepted Accounting Principles (GAAP) or the International Financial Reporting Standards (IFRS). Additionally, professional organizations such as the American Institute of Certified Public Accountants (AICPA) provide ethical codes that outline expected behaviors, including avoiding conflicts of interest and ensuring financial statements are not misleading.

Respect for the accounting profession also plays a crucial role in upholding ethical conscience. Accountants must remain committed to integrity, even in challenging situations where financial misrepresentation or fraud may be tempting. Ethical behavior strengthens public trust in the profession and reinforces accountability.

My Plan for Remaining an Ethical Accountant

To ensure that I uphold ethical standards as an accountant, I will:

  1. Commit to Ongoing Education – Stay informed about accounting regulations, industry best practices, and ethical guidelines by attending professional development courses and obtaining certifications.
  2. Follow Ethical Frameworks – Adhere to the AICPA Code of Professional Conduct and internal company policies that promote honesty and transparency.
  3. Seek Guidance When Needed – Consult with supervisors, mentors, or ethics boards when facing ethical dilemmas to make informed, principled decisions.
  4. Maintain Professional Skepticism – Approach financial reporting with a critical mindset, verifying the accuracy of data and ensuring compliance with regulations.
  5. Lead by Example – Encourage ethical behavior among colleagues by promoting accountability and fostering a culture of integrity in the workplace.
  6. Report Unethical Practices – If I encounter unethical behavior, I will follow appropriate reporting procedures, such as whistleblowing protocols, to prevent fraud or misconduct.
 
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ICS Response to Mass Casualties

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ICS Response to Mass Casualties

(ICS Response to Mass Casualties)

Incident command system relation to mass casualty incident management

Research a recent mass casualty event. Provide links to articles related to the event.

Analyze and evaluate the event in relation to Mass Casualty Incident Management.

  • How would you have organized the event (ICS Chart), what resources do you feel should be summoned to the event, and how long would it take to assemble these resources in your area?
  • What plans are in place and how confident are you in the plans success to handle this type of event in your community? 400 words APA Format with no less than 3 peer reviewed sources.

Strategic Valuation Insights Explored

The Incident Command System (ICS) is a standardized, flexible framework designed to manage incidents of all sizes and complexities, including mass casualty incidents (MCIs). Its primary objective is to ensure effective coordination among various agencies, optimize resource utilization, and maintain clear communication during emergencies.

Recent Mass Casualty Event: New Orleans Truck Attack

On January 1, 2025, a tragic incident occurred in New Orleans when a driver rammed a pickup truck into a crowd on Bourbon Street, resulting in at least 14 fatalities and over 30 injuries. The FBI is investigating the attack as an act of terrorism.

Analysis and Evaluation in Relation to Mass Casualty Incident Management

In response to the New Orleans truck attack, the ICS framework would have been instrumental in organizing and coordinating the emergency response. The system’s structure, which includes roles such as Incident Commander, Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance/Administration Section Chief, ensures a systematic approach to managing resources, information, and personnel.

Organizational Structure (ICS Chart) and Resource Allocation

In this scenario, the ICS chart would be organized as follows:

  • Incident Commander: Oversees the overall response efforts.
  • Operations Section Chief: Manages tactical operations, including medical care and law enforcement activities.
  • Planning Section Chief: Develops incident action plans and maintains situational awareness.
  • Logistics Section Chief: Provides necessary resources and services, such as medical supplies and transportation.
  • Finance/Administration Section Chief: Handles financial aspects and documentation.

Resources to be summoned would include:

  • Medical Teams: Emergency medical technicians (EMTs), paramedics, and trauma surgeons.
  • Law Enforcement: Local police, federal agencies, and bomb squads.
  • Fire Services: Firefighters equipped for rescue operations.
  • Emergency Medical Services (EMS): Ambulances and specialized medical units.
  • Support Services: Mental health counselors, public information officers, and logistical support teams.

The assembly time for these resources would depend on their proximity and availability. Given the urban setting of New Orleans, local resources could be mobilized within minutes, while additional support from neighboring regions might take several hours.

Community Preparedness and Confidence in Plans

New Orleans has established comprehensive plans for handling mass casualty incidents, including the implementation of the National Incident Management System (NIMS) to guide coordinated responses.

However, the tragic event on January 1, 2025, highlighted certain vulnerabilities, such as gaps in physical security measures and the need for enhanced interagency communication. The partially completed street barriers, intended to prevent such attacks, were not fully operational at the time, underscoring the importance of timely infrastructure improvements.

While the community has a solid foundation for emergency response, the incident revealed areas for improvement, particularly in infrastructure readiness and interagency coordination. Addressing these gaps is crucial to enhance the effectiveness of future responses to mass casualty incidents.

References

 
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Medical Coding and Reimbursement

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Medical Coding and Reimbursement

(Medical Coding and Reimbursement)

Medical coding questions.

the following procedures:

  • Endometrial biopsy
  • Pelvic ultrasound
  • TDAP immunization
  • Maxillofacial prosthetics, unlisted procedure
  • X-ray of stomach
  • Coombs test
  • Intracapsular lens extraction

Choose correct CPT codes and type the code next to its corresponding procedure. Also, within the Word document, underline the key term utilized to locate the code.

Create a scenario where HCPCS Level I and Level II are used together. Explain how the HCPCS level determines payer responsibility and why documenting this information accurately is directly linked to reimbursement from the insurance company.

CPT Codes for Procedures

  1. Endometrial biopsy – 58100
    Key term: Biopsy, endometrium
  2. Pelvic ultrasound – 76856
    Key term: Ultrasound, pelvis
  3. TDAP immunization – 90715
    Key term: Immunization, TDAP
  4. Maxillofacial prosthetics, unlisted procedure – 21089
    Key term: Prosthetics, maxillofacial
  5. X-ray of stomach – 74022
    Key term: X-ray, stomach
  6. Coombs test – 86880
    Key term: Test, Coombs
  7. Intracapsular lens extraction – 66920
    Key term: Extraction, lens, intracapsular

Scenario Using HCPCS Level I and Level II

Scenario:
A patient presents for a TDAP vaccination (CPT: 90715) and requires the use of an immune globulin product (HCPCS Level II: J1670) to address an allergy concern related to the vaccine.

  • Explanation of HCPCS Levels and Payer Responsibility:
    HCPCS Level I includes CPT codes for services and procedures performed by healthcare providers, such as the administration of the TDAP vaccine (90715). HCPCS Level II includes codes for supplies, medications, and other products not included in CPT, such as the immune globulin product (J1670).

    Payer responsibility is determined by the type of HCPCS code used. For example:

    • Level I (CPT codes): Covers professional services and procedures.
    • Level II: Covers supplies and medications, often reimbursed under durable medical equipment (DME) or drug formularies.

    Documenting this information accurately ensures proper reimbursement. Errors in coding or omissions (e.g., failing to include the Level II code for immune globulin) could result in claim denial or underpayment. Correct documentation ensures compliance with payer guidelines, mitigates audit risks, and improves revenue cycle management.

 
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HIV Prevention Across Cultures

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HIV Prevention Across Cultures

(HIV Prevention Across Cultures)

HIV prevention plan

You will be creating an HIV prevention plan. This plan will focus on how to reduce new HIV infections among heterosexuals, homosexuals, IV drug users, infants/children, or adolescents in a culture of your choice.

How you go about this is up to you, but it is important to use the research when formulating your plan. Any variables you select should be backed up by research.

In 1,000-1,500 words, do the following:

  1. Choose a culture. Gain approval for the culture with your instructor before you begin this assignment.
  2. Describe the characteristics of the culture for which you are planning a prevention program. What is their background? Historically do they have a positive or a negative relationship with health care/prevention? Why is it important to implement a prevention program for this culture? Why do you think this is an important culture to apply a prevention program to (risk factors/current rates of HIV)?
  3. Describe several facets of your plan. What variables (e.g., education) will you choose to focus on and why (make sure your why connects directly to the background of your culture)? You should use research to support the variables chosen for your plan.
  4. Using research and psychological principles to support your plan, discuss how you would make this plan successful in your chosen culture. Include information on how you would positively affect variables to promote success. Discuss how you would implement such a plan logistically (Who specifically would you target for your plan and why? Where your plan would be based? How would your plan be different from those that are currently out there? Do you anticipate any obstacles? How do you plan to overcome them?).

Your plan should be written in paragraph form (not in bullet points), but an “introduction” and “conclusion” are not necessary.

You should use four to six outside peer-reviewed journal articles to formulate your response. These should be cited in-text as well as in your References section.

 
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Refuting Skipping Routine Checkups

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Refuting Skipping Routine Checkups

(Refuting Skipping Routine Checkups)

For this activity, you will practice engaging in argumentation by refuting an argument published in the New York Times about skipping yearly routine doctor visits

Engaging in argumentation

1. Identify the Core Argument

  • Premise: The article in the New York Times argues that skipping yearly routine doctor visits may be acceptable, citing reasons such as the cost of healthcare, the potential for unnecessary treatments, or a belief that patients can monitor their health without frequent medical checkups.
  • Thesis: The main claim likely suggests that the benefits of skipping routine checkups (e.g., cost-saving, reducing unnecessary treatments) outweigh the potential risks.

2. Refute the Argument

a) Challenge the Assumption of Cost-Effectiveness

  • While it’s true that medical visits can be costly, the long-term cost savings from preventative care (e.g., early detection of chronic conditions, screening for diseases like cancer, or monitoring ongoing conditions like hypertension) can actually save money.
  • Evidence: Studies have shown that regular check-ups can help reduce the need for more expensive emergency care or hospitalizations later on by catching health problems early.

b) Counter the Claim of Unnecessary Treatments

  • The idea that routine doctor visits lead to unnecessary treatments is often overstated. Many of these treatments or tests are preventive measures, such as vaccinations or screenings, which help in detecting health issues before they become serious or expensive.
  • Evidence: Research from organizations like the CDC or the World Health Organization supports the role of regular checkups in improving long-term health outcomes.

c) Emphasize the Role of Preventive Health Care

  • Preventive healthcare is essential to reducing long-term healthcare costs and improving quality of life. Skipping these visits could lead to conditions worsening before being noticed, increasing the risk of severe complications or costly interventions.
  • Evidence: According to the U.S. Preventive Services Task Force (USPSTF), regular screenings and checkups for conditions like diabetes, heart disease, and certain cancers can significantly lower mortality rates.

d) Challenge the Assumption that Individuals Can Adequately Monitor Their Health

  • While individuals may feel they can manage their health, many health issues, especially chronic diseases, have no symptoms in the early stages. Doctors are trained to detect signs that may go unnoticed by a layperson.
  • Example: High blood pressure, high cholesterol, and certain cancers often show no symptoms but can be detected through routine exams.

3. Conclusion

  • The practice of skipping yearly doctor visits may seem financially attractive in the short term, but the long-term health implications and potential cost increases due to undiagnosed conditions should not be overlooked. Preventive care, even in its basic form of yearly checkups, can ultimately save lives and reduce overall healthcare expenses.
 
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Enhancing Care Quality Initiatives

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Enhancing Care Quality Initiatives

(Enhancing Care Quality Initiatives)

Improving quality.

APA FORMAT

350-500 WORDS

Discussion: Improving Quality

Improving the quality of health care delivery and patient safety continues to be a political concern and has been at the heart of reform issues for many years. The American Nurses Association (ANA) and the Institute of Medicine (IOM) have increased awareness of health care quality and safety issues, as well as advocated for health care reform. The documents featured at the ANA and IOM websites listed in this week’s Learning Resources focus on many of the current issues surrounding quality and safety in the health care industry.

To prepare:

  • Review this week’s Learning Resources, focusing on the Six Aims for Improvement presented in the landmark report Crossing the Quality Chasm: The IOM Health Care Quality Initiative.
  • Consider these six aims with regard to your current organization, or one with which you are familiar. In what areas have you seen improvement? What areas still present challenges? As a nurse leader, how can you contribute to improving the organization’s achievement of these aims?
  • Select one specific quality or safety issue that is presenting a challenge in the organization. Consider at least one quality improvement strategy that could be used to address the issue, as well as which of the six aims for improvement would then be addressed.
  • Reflect on your professional practice and your experiences with inter-professional collaboration to improve quality and safety. How has inter-professional collaboration contributed to your organization’s efforts to realize the IOM’s six aims for improving health care? Where has inter-professional collaboration been lacking?

Post a description of the quality or safety issue you selected and a brief summary of the impact that this issue has on health care delivery. Describe at least one quality improvement strategy used to address this issue. Then explain which of the six aims for improvement are addressed by the strategy. Finally, explain how inter-professional collaboration helps improve quality in this area.

Six Aims for Improvement

Advances must begin with all health care constituencies–health professionals, federal and state policy makers, public and private purchasers of care, regulators, organization managers and governing boards, and consumers–committing to a 2

Advances must begin with all health care constituencies committing to a national statement of purpose

national statement of purpose for the health care system as a whole. In making this commitment, the parties would accept as their explicit purpose  to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States. The parties also would adopt a shared vision of six specific aims for improvement. These aims are built around the core need for health care to be:

  •  Safe: avoiding injuries to patients from the care that is intended to help them.
  •  Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
  • Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
  • Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care. • Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.
  • Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

A health care system that achieves major gains in these six areas would be far better at meeting patient needs. Patients would experience care that is safer, more reliable, more responsive to their needs, more integrated, and more available, and they could count on receiving the full array of preventive, acute, and chronic services that are likely to prove beneficial. Clinicians and other health workers also would benefit through their increased satisfaction at being better able to do their jobs and thereby bring improved health, greater longevity, less pain and suffering, and increased personal productivity to those who receive their care.

 
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Metabical Marketing Strategy Analysis

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Metabical Marketing Strategy Analysis

(Metabical Marketing Strategy Analysis)

Case analysis.

Review the Metabical Case and answer the following questions:

  1. How does Metabical compare to current weight-loss options?
  2. Which demand (unit) forecast would you select for the first five years?
  3. What considerations should be taken into account when making decisions about the package count? What package size would you recommend?
  4. What pricing strategy approaches would you suggest Printup explore? What are the advantages and disadvantages of each strategy? What price would you recommend?
  5. What impact does your pricing decision have on profitability? What is ROI over the first five years for each of the pricing strategies identified?

Answers to the above questions.

  1. How does Metabical compare to current weight-loss options?

Advantages:

FDA Approval: Metabical is the only FDA-approved weight-loss drug, providing credibility and safety assurance.

Target Market: It is specifically designed for overweight individuals (BMI of 25-30), a demographic often overlooked by other weight-loss solutions.

Dual-Action Mechanism: Combines appetite suppression with fat absorption regulation.

Support Program: Comes with a comprehensive program that includes dietary and lifestyle guidance, enhancing its appeal to consumers looking for a structured plan.

Mild Side Effects: Positioned as safer with fewer side effects compared to other prescription options.

Disadvantages:

Narrow Target Audience: Not suitable for obese individuals (BMI > 30) or those seeking a purely cosmetic weight-loss solution.

Lifestyle Change Dependency: Requires adherence to diet and exercise for optimal results, which may deter customers seeking a “quick fix.”

Cost: Likely more expensive than non-prescription weight-loss options like supplements or over-the-counter products.

 2. Which demand (unit) forecast would you select for the first five years?

Key Factors for Demand Forecasting:

Target Population Size: The number of overweight individuals in the target BMI range.

Adoption Rates: How quickly consumers adopt Metabical, considering marketing efforts and physician endorsements.

Retention Rates: How many customers will complete the recommended treatment regimen (e.g., 12 weeks).

Competitive Landscape: Consider how competitors or new entrants could impact market share.

Recommended Forecast:

Select a moderate forecast that balances optimistic early adoption and realistic barriers to entry, such as consumer skepticism or cost concerns.

Example: Assume 3-5% market penetration in Year 1, scaling up to 10-15% penetration by Year 5, driven by increased awareness and positive word of mouth.

 3. What considerations should be taken into account when making decisions about the package count? What package size would you recommend?

Considerations:

Treatment Duration: A 12-week regimen is standard, so package sizes should align with this duration.

Consumer Preferences: Smaller packages (e.g., 4 weeks) allow first-time users to trial the product without committing to the full cost upfront.

Pharmacy Storage & Inventory: Package sizes should be easy for pharmacies to stock and handle.

Cost Perceived by Consumers: Larger packages may offer better value per dose, but upfront costs could deter consumers.

Recommendation:

    • Two Options:

4-week supply: A trial package for first-time users to encourage initial adoption.

12-week supply: A full treatment package to maximize adherence and convenience.

4. What pricing strategy approaches would you suggest Printup explore? What are the advantages and disadvantages of each strategy? What price would you recommend?

Pricing Strategies:

  • Premium Pricing:

Advantage: Reflects the unique, FDA-approved, and safe positioning of Metabical.

Disadvantage: Higher cost may deter price-sensitive consumers.

  • Penetration Pricing:

Advantage: Attracts early adopters and builds market share quickly.

Disadvantage: Low price may devalue the brand’s premium positioning and reduce profitability.

  • Value-Based Pricing:

Advantage: Price reflects perceived value of FDA approval, efficacy, and support program.

Disadvantage: Requires effective communication of the product’s unique value proposition to justify the price.

  •  Tiered Pricing:

Advantage: Offers pricing flexibility, such as discounts for bulk purchases or long-term packages.

Disadvantage: Complex implementation and potential confusion for consumers.

Recommended Price:

    • $150-$200 per 4-week supply: This reflects the premium nature of the product while remaining competitive with prescription weight-loss drugs.
     5. What impact does your pricing decision have on profitability? What is ROI over the first five years for each of the pricing strategies identified?

Impact on Profitability:

Higher Pricing: Maximizes profit margins but risks lower adoption rates.

Lower Pricing: Drives higher sales volume but may reduce margins, especially given Metabical’s high R&D and marketing costs.

ROI Calculation:

Consider revenue (unit sales × price) minus costs (manufacturing, R&D, marketing, distribution).

ROI is affected by:

      • Adoption Rate: Lower price increases volume.
      • Retention Rate: Larger package sizes encourage full regimen completion.
      • Gross Margin: A premium price provides higher margins per unit.

For example:

Premium pricing ($200/unit): ROI could range from 20-30% over five years if penetration grows steadily.

Penetration pricing ($100/unit): ROI may only reach 10-15% but establishes a stronger market foothold.

 
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Diagnosing Sexuality and Identity

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Diagnosing Sexuality and Identity

(Diagnosing Sexuality and Identity)

Case study sexual dysfunction and gender dysphoria

For many beginning psychologists, one of the most difficult topics to broach with a client is the topic of sex: sexual behavior, sexual identity, or sexual problems. By using professional sensitivity and consideration of other personal factors such as cultural awareness and client privacy, psychologists may produce a comfortable environment in which to lead the client into discussion.

The application this week consists of two parts. The first part is written based on the video case study. The man is the client. The second part is written based on the description of the 13 year old female listed below. She is the client. Do not forget to address both parts of the application. Provide a diagnosis and a complete rationale for both clients.

For the first part of this application, you review the client in the case study. Give a DSM-5 diagnosis for the presenting problem. Include an assessment of the client’s ability to function in daily life. Be sure to pay particular attention to symptoms of the disorder and the influence of the disorder on the client as well as the client’s significant other.

For the second part, imagine a 13-year-old female client is brought by her parents to see you. Her parents are concerned because they report their daughter is very unhappy with being a girl. She is increasingly being teased at school because she looks, dresses, and tries to act like a boy. She is an active athlete, but will only play contact sports with boys. The client states she does not like her breasts and wishes she could have them removed. She reports that she has always wanted to be a boy for as long as she can remember. Give a DSM-5 diagnosis for the presenting problem. Include an assessment of the client’s ability to function in daily life. Be sure to pay particular attention to the symptoms of the disorder and the influence it has on the client, as well as the client’s family.

The Assignment (3-4 pages)

  • A DSM-5 diagnosis of each client
  • An explanation of your rationale for assigning these diagnoses on the basis of the DSM-5
  • An explanation of what other information you might need about each client to make an accurate diagnosis
  • A brief description of additional individuals you might include in your assessment and explain why
  • Discuss how you would produce a comfortable environment to lead your clients to discuss their issues

Be sure to support your postings and responses with specific references to current literature.

3-4 Pages. APA Format. In-text Citations to Support Literature. Minimum of 4 Peer Reviewed References.

 
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Reviving Compliance Program Integrity

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Reviving Compliance Program Integrity

(Reviving Compliance Program Integrity)

Compliance program final.

Introduction

For this project, you are to apply the foundation knowledge you have acquired throughout this course and evaluate the model medical practice described here for you. You are the incoming Compliance Officer at Grace University Hospital. You have a staff of five coder/auditors, one systems analyst, and an office manager. All are full-time employees and have been part of the medical practice team for 15+ years.

There is a significant bias against the Compliance Program. You have been hired to evaluate, develop a mitigation strategy and put the program back on track with the guidelines as expected by the Federal and State governments. You also need to build credibility back into the program. The focus for this Compliance program project is on the Billing Compliance Program as it is responsible for the integrity of the medical record, privacy and security of health information (HI), accuracy of the assignment of billing codes and complete, and accurate documentation that reflects the services reported for reimbursement. There is a separate Compliance Program for Research and HR/Legal; however, your program collaborates extensively with Research and Legal. You also sit at the laboratory Compliance Committee and provide guidance as appropriate.

Existing Compliance Program

The corporate compliance program has essentially been inactive for three years and no audits have been completed during this time. There is pervasive mistrust of the compliance program. The compliance committee meets occasionally and not at all in the last year. There is no hotline or any publicized avenue of reporting for the general staff or patient population. The previous compliance officer was not in good standing with the medical staff because of enforced paybacks to the Medicare program. The existing policy and procedure manuals are outdated. There is no method in place for disseminating updated regulations or changes in policy. No one is able to provide you with any baseline information regarding billing or documentation compliance. There is no regular communication between the billing staff and the practice regarding denial, report requests or suspend trends.

You have received complaints for the following:

a) EMTALA violations

b) Fraudulent billing practices

c) Stark violations involving referrals to provider-owned laboratories

d) Medical identity theft

e) Security breaches

Staffing

The skillset of the staff is the following:

Three coder/auditors ‘CPC, CHC certified with a minimum of a bachelor’s degree in healthcare management or a related field.

Two coder/auditors CCS, CHC certified with a minimum of a bachelors degree ibn healthcare management or a related field.

Systems Analyst BS in computer engineering and 5+ yearsexperience in Epic, MediTech, HPF and Cerner. The analyst is also facile in database design and management.

Office Manager  BA in English with a minor in Drama and skilled in all Microsoft Office applications. She has special skills in project management, SharePoint and Access.

Practice Profile

Specialty Areas

The medical practice is a multispecialty group practice that provides services in a teaching (PATH) institution. Both inpatient and ambulatory services are provided on the campus as well as in three satellite clinics. Radiology, pathology and laboratory services are provided under the umbrella of the institution. Residents rotate through all specialty areas and provide services both under the direction of the faculty attendings as well as directly in pediatrics and Internal Medicine under the Primary Care Exception.

Specialty

Physicians

Physician Assistant

Nurse Practitioner

Comment

Internal Medicine

Basic preventative and minor care; imaging is sent out, minor lab such as cell smears, fungal scrapings and UA are completed in the practice offices

Pediatrics

Basic preventative and minor care; imaging is sent out, minor lab such as cell smears, fungal scrapings and UA are completed in the practice offices. CHDP type examinations are done to report need for public health nurse intervention.

Cardiology

Consultative service primarily. Some cath lab procedures also performed.

General Surgery

Both ambulatory and inpatient services provided.

Dermatology

Outpatient procedures only; self-referrals; independent lab for special derm services

Endocrinology

Consultative services

Oncology

Large infusion center managed by RNs

Orthopedics

Several Divisions including Joint Prosthetics, Sports Medicine and Foot & Ankle

Payer Mix

Contracts – 35%

Medicare – 20%

Medicaid – 15%

Capitated – 5%

Medicare Part C- 5%

Workers’ Comp/Industrial -5%

Full Indemnity/PPO – 10%

Self-Pay -5%

(Reviving Compliance Program Integrity)

Trends:

Revenue Cycle:

1. Trend in denials for consultations provided by Cardiology and Endocrinology after documentation provided

2. Incorrect billing noted for Infusion Center with multiple denials for antineoplastic and administration

3. Problems getting payment for services provided by nonMD Practitioners

4. Services by Orthopedics and provided in the ED are undocumented

5. General complaints from patients alleging rude and abusive behavior referred to Compliance

Compliance:

1. Multiple calls from staff reporting fraudulent billing practices

2. Attendings billing for services provided only by house staff

3. Providers referring to their own laboratory

4. Reports of non-existent documentation

5. Reports of billing staff changing codes

6. Report from ED of EMTALA violations

7. Report of any Fraud and Abuse Activity

Privacy:

1. Medical record breach of celebrity seen at hospital

2. Report of patient attempting to use another’s insurance card

3. Multiple accesses, some unauthorized, on a high-profile chart

4. Poor recording-keeping for Privacy Office

5. Process for maintaining behavioral client records in the field

Research:

1. Stark violations involving referrals to provider-owned laboratories

2. Failure to separate routine charges from those billed to the grant

3. Irregular management of consents

4. Allegations of misconduct (principal moving ahead with publications after receiving a letter to cease)

External Audits:

1. Complaint-based investigation regarding a FEMLA denial

2. FMR for surgical practice regarding package unbundling

3. OIG Investigation for violation of P.A.T.H. regulations

Fraud Article: http://bok.ahima.org/doc?oid=103625#.WVKHQhMrI3g

(Reviving Compliance Program Integrity)

Final Project Deliverables

You will be creating and submitting a Corporate Compliance Plan for Grace University Hospital. You will be submitting ONE (1) plan, but your plan will include several attachments. These attachments include the assignments that you have completed within this course. Make sure you review and update your assignments with any feedback I have provided. Together, they will form a complete compliance plan for this Use Case. 20 Points

As a component of the overall Corporate Compliance Plan, you will be required to provide:

1. Roles and structure of the Department: Organization Chart and Sample Position Descriptions for Corporate Compliance, HIPAA Privacy Officer and Risk Manager. Additionally, assess whether the Department meets the criteria for the seven sentencing guidelines and explain how it will satisfy these suggestions for mitigating exposure. Include your assessment in the Corporate Compliance Plan in addition to your presentation as a teaching tool of the Seven Sentencing Guidelines. 20 Points

(Reviving Compliance Program Integrity)

Documents:

a) Sample Position Descriptions (Corporate Compliance, HIPAA Privacy Officer, and Risk Manager) Completed in Unit 1, Week 1

b) Stark & Whistleblower Presentation Completed in Unit 1, Week 2

2. Training Plan: Based on industry information, CMS guidance, past audits and OIG targets, develop an Annual Plan of what you believe is addressable in your practice. This will include an education schedule within the Corporate Compliance Plan, your plan for tracking and monitoring the training and your plan for changes in the plan due to the identified risks identified in the Use Case. Additionally include the following Training Plans as attachments that were completed earlier in the course. Make sure you make any necessary updates based on my feedback. 20 Points

Training Plan Documents  All Completed in Unit 3, Week 7:

a) Corporate Compliance

b) Risk Management

c) HIPAA

d) Identity – Medical Theft

3. Provide a description of the Audit Program within the Corporate Compliance Plan. This should include a department policy to include types of audits that will be conducted, schedule of routine audits, what the sampling methodology will be, identification of who will pull the cases and how the field work is to be completed, and follow-up and refunding procedures. This will be supported by attaching your Audit Program Assignment documents. Make sure to make any necessary updates to the documents as part of the Audit Program Assignment. 20 Points

Audit Program Assignment Documents:

a) A brief policy & procedure for the assignment, initiation & close of the Audit – Completed in Unit 1, Week 4

b) Outline of the resulting report (you do not need to write a report an outline of the sections is required) – Completed in Unit 1, Week 4

c) Sample entrance and follow up letters Completed in Unit 1, Week 4

d) Include a section into the Audit Policy and Procedure that will create surveillance model to detect fraud and abuse within the healthcare organization (just a statement or two  nothing too big) – New

e) Include a forensic model for fraud and abuse surveillance (find on the Internet  you don’t have to create) New

4. Privacy and Security: Your department is not responsible for Privacy and Security but you receive a number of reports concerning privacy and security issues. The responsible department expects your cooperation and collaboration. Identify a system for filing documents used for state and federally mandated reporting and strict fieldwork. Additionally, identify Investigation Process, Policy & Procedures within the Corporate Compliance Plan. You have been asked to assist with developing a tracking system, for privacy and security concerns. 20 Points

HIPAA & Security Contingency Plan Documents:

a) Security Contingency Plan Completed in Unit 3, Week 6

b) Example Policy for Breach Investigations (find one don’t create) New

a. You don’t have to create this but rather find an example of a policy online to include

c) Creation of an Electronic Breach Tracking Process  New

a. You should create an electronic tool that will let you track breach investigations and outcomes.

b. This tool should be able to be used to determine trends or issues in the organization. Recommendation is to complete using Microsoft Excel.

 
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Effective Collaboration in Healthcare

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Effective Collaboration in Healthcare

(Effective Collaboration in Healthcare)

Overview

Explain the concept of true collaboration in health care and describe the benefits of effective interdisciplinary collaboration. Then, describe the characteristics required for effective collaboration, describe barriers to collaboration, and offer evidence-based strategies to overcome those barriers.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Explain the principles and practices of highly effective interdisciplinary collaboration.
    • Explain the concept of collaboration in health care.
    • Describe the characteristics and concepts required for effective interdisciplinary collaboration.
    • Describe barriers to effective interdisciplinary collaboration.
    • Identify evidence-based strategies to overcome barriers to effective interdisciplinary collaboration.
  • Competency 3: Explain the internal and external factors that can affect the health of individuals, families, communities, and populations.
  • Describe the benefits of effective collaboration and teamwork in health care for patients, organizations, and team members.

Context

Every day, in every patient setting, health care professionals must interact with other health care professionals, as well as with providers from other professions to share information, conduct safety and quality checks, and work with patients in a variety of ways to make sure they understand their health care needs and will be more likely to comply with treatment plans.

Research consistently shows that interdisciplinary collaboration and teamwork improves the quality and safety of patient care by recognizing the skills and experience of each team member, allowing the team to function more effectively and efficiently.

Assessment Instructions

You are part of an interdisciplinary team that has been highly effective. Your supervisor asks you to write a short article about why the team has been so successful and submit it to the organizational newsletter for publication.

Preparation

Search the Capella library and the Internet for peer-reviewed journal articles on collaboration and teamwork in health care. You will need at least 3 articles to support your work on this assessment.

Directions

In the article you write for this assessment, be sure you do the following:

  • Explain the concept of true collaboration in health care.
  • Describe the benefits of effective collaboration and teamwork in health care for the following groups:
    • Patients.
    • Organizations.
    • Team members.
  • Describe the characteristics and concepts required for effective interdisciplinary collaboration.
  • Describe barriers to effective interdisciplinary collaboration.
  • Identify evidence-based strategies to overcome barriers to effective interdisciplinary collaboration.
  • Format this assessment according to current APA style and formatting guidelines.

Additional Requirements

  • Include a title page and reference page.
  • Ensure your assessment is 3-4 pages.
  • Use double-spaced, 12-pt., Times New Roman font.

Collaboration and Teamwork in Health Care Scoring Guide(Effective Collaboration in Healthcare)

CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Explain the concept of collaboration in health care. Does not explain the concept of collaboration in health care. Explains the concept of collaboration but not in the context of health care, or the explanation is missing key elements. Explains the concept of collaboration in health care. Explains the concept of collaboration in health care and describes the unique aspects of collaboration in health care.
Describe the benefits of effective collaboration and teamwork in health care for patients, organizations, and team members. Does not describe the benefits of effective collaboration and teamwork in health care for patients, organizations, and team members. Describes the benefits of effective collaboration and teamwork in health care for patients, organizations, or team members (or two of these) but not all three. Describes the benefits of effective collaboration and teamwork in health care for patients, organizations, and team members. Describes the benefits of effective collaboration and teamwork in health care for patients, organizations, and team members and considers the consequences of ineffective collaboration and teamwork.
Describe the characteristics and concepts required for effective interdisciplinary collaboration. Does not describe the characteristics and concepts required for effective interdisciplinary collaboration. Lists the characteristics and concepts required for effective interdisciplinary collaboration. Describes the characteristics and concepts required for effective interdisciplinary collaboration. Describes the characteristics and concepts required for effective interdisciplinary collaboration and explains how each contributes to more effective collaboration.
Describe barriers to effective interdisciplinary collaboration. Does not describe barriers to effective interdisciplinary collaboration. Identifies barriers to effective interdisciplinary collaboration. Describes barriers to effective interdisciplinary collaboration. Describes barriers to effective interdisciplinary collaboration and considers possible causes for the barriers.
Identify evidence-based strategies to overcome barriers to effective interdisciplinary collaboration. Does not identify evidence-based strategies to overcome barriers to effective interdisciplinary collaboration. Identifies strategies to overcome barriers to effective interdisciplinary collaboration but does not provide supporting evidence. Identifies evidence-based strategies to overcome barriers to effective interdisciplinary collaboration. Identifies evidence-based strategies to overcome barriers to effective interdisciplinary collaboration and suggests methods for implementing the strategies.
Write content clearly and logically, with correct use of grammar, punctuation, and mechanics. Does not write content clearly, logically, or with correct use of grammar, punctuation, and mechanics. Writes with errors in clarity, logic, grammar, punctuation, or mechanics. Writes content clearly and logically, with correct use of grammar, punctuation, and mechanics. Writes clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics; uses relevant evidence to support a central idea.
Correctly format paper, citations, and references using current APA style. Does not correctly format paper, citations, and references using current APA style. Uses current APA to format paper, citations, and references but with numerous errors. Correctly formats paper, citations, and references using current APA style with few errors. Correctly formats paper, citations, and references, with no errors.
 
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