Assignment: Provide one detailed example of each scenario listed and explain the regulatory language surrounding the action. Support your answer with a minimum of two APRN peer-reviewed resources
Assignment: Provide one detailed example of each scenario listed and explain the regulatory language surrounding the action. Support your answer with a minimum of two APRN peer-reviewed resources
Provide one detailed example of each scenario listed and explain the regulatory language surrounding the action. Support your answer with a minimum of two APRN peer-reviewed resources.
An appropriate inpatient admission for Medicare.
An appropriate outpatient admission for Medicare.
An example of an appropriate Medicare patient appeal for delay in discharge.
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Week 16-2 Scenario
Inpatient Admission for Medicare
Patient M presents to the hospital ED with signs and symptoms of acute abdominal pain. The nurse at the department quickly evaluates the patient and records the presenting complaints. The attending nurse conducts a thorough physical examination and draws blood samples for appropriate tests to rule out various causes. Focused abdominal ultrasound is also conducted. The nurse admits the patient and starts the necessary treatment plan based on the results. As per the requirements of Medicare, every patient that presents in a critical condition requires thorough examination, conducting appropriate test before admission, and initiating appropriate treatment action (El-Nahal, 2020).
Outpatient Admission for Medicare
A Medicare beneficiary patient presents to the outpatient clinic for regular debridement of her diabetic foot. Upon visitation, a thorough systemic evaluation is conducted on her diabetic foot to determine the condition of the foot. The physician writes her the appointment dates for doing the debridement. Adetailed record is then documented and shared with Medicare for the updates and remission of funds.Authorized outpatient services are catered for by Medicare (Kaiksow et al., 2020). Constant update on patient’s progress is necessary for the reimbursement of funds by Medicare.
Medicare Patient Appeal for Delay in Discharge
A patient treated with malaria complains to Medicare that hospital X has prolonged her discharge, yet she has fully recovered. She has completed her anti-malarial dosage and feels that the current medications do not affect her much. The delayed discharge also accumulates unnecessary hospital charges for her. The patient requested Medicare to scrutinize her records to evaluate if it justified the prolonged hospital stay. Medicare advocates for the discharge of patients if they are stabilized, and the treatment received is not medically required (Shapiro et al., 2022).
References
El-Nahal, W. (2020). An overview of Medicare for clinicians. Journal of General Internal Medicine, 35, 3702-3706. https://link.springer.com/article/10.1007/s11606-019-05327-6
Kaiksow, F. A., Powell, W. R., Ankuda, C. K., Kind, A. J., Jaffery, J. B., Locke, C. F., & Sheehy, A. M. (2020). Policy in clinical practice: Medicare advantage and observation hospitalizations. Journal of Hospital Medicine, 15(1), 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6932592/pdf/0150006.pdf
Shapiro, M. H., Goodman, D. M., & Rodriguez, V. A. (2022). In Search of the Perfect Discharge: A Framework for High-Quality Hospital Discharges. Hospital Pediatrics, 12(1), 108-117. https://doi.org/10.1542/hpeds.2021-006100