Requirements
Submissions
1- Pediatrician
2- Systems-Based Practice
3- Case Report
4- Service Learning
examples
Ambulatory Community Selective: Pediatric Option
Module 2: Systems-Based Practice
Due:
by 9:00 PM Wednesday of Week 3
The purpose of this module is to familiarize the students about the complexities of the health care system and how to practice quality health care and advocate for patients within the context of this system.
Follow these steps
1. Read the ten questions below so you'll know what you need to be looking for.
2. Work the Case of Christina
3. Study this resource on Coding and speak to the Practice Manager about coding. AAFP article on documentation and coding with Level of Service Table .
4. Go here to learn about health insurance plans in Texas
5. Read a brief overview about HIPAA at this site:
UTMB Office of Institutional compliance6. Work through the HIPAA Module at this site:
UTMB Dept. Pediatrics, HIPAA Curriculum
Submission: Ten Questions
Instructions:
1.
Capture the questions with mouse, copy and paste into e-mail or Word
document, answer the questions, save, and send as e-mail attachment.
2.
Be sure to put your name at
the top of the document
3. Submit answers
by e-mail to Course Directors (Gayani Silva,
MD, gsilva@utmb.edu and Virginia
Niebuhr, PhD, vniebuhr@utmb.edu )
AND to ACS Coordinator, Lisa Mignerey
lmmigner@utmb.edu
Billing:
|
1. What is the most suitable
CPT code for Christina?
2. How does documentation and billing for an established patient differ from a new patient?
3. If Christina also needs a well-child visit today, can we complete a sick visit and a well-visit today? Can we bill for both or one? What documentation is required?
4. When you were writing a prescription for eye drops for Christina, her mother requested that the prescription include option for 1-2 refills. She explains that she is certain that Juan is also developing conjunctivitis, but his Medicaid insurance has expired. Explain why you would or would not write your patient’s prescription with a refill option?
Insurance
5.
Complete this
table and submit:
|
INSURANCE |
Medicaid | CHIPS (Children’s Health Insurance Program) |
any other third-payor
insurance: |
|
| Eligibility/income requirements |
|
what is the difference between HMO and PPO? |
||
| Funding source for program |
|
|||
|
For Christina's visit(established
, sick visit), what is the co-payment under different plans |
|
|
6. What children likely do not have insurance or insurance eligibility, and what are the healthcare options for these children?
HIPPA-Privacy
7. What is a privacy notice and which
patients receive these?
8.
When the physician communicates with a specialist
regarding the patient’s care, is it necessary to first get the parent's written authorization/
9. Given HIPAA rules, what are some possible issues with electronic data and technology (PDA’s and emails)? Can you keep patient information in PDA’s?
10. What steps can you see in this practice that show evidence that
the HIPAA Privacy Rule is being followed?
