Pediatrics

 

Ambulatory Community Selective
Pediatric Option 

MODULE 2:  Systems-Based Practice
 Due by Friday of Week 3

Objective
 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.   

Activities
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 for Texans with no or low income.

5.  Read more about HIPAA at this site:
          US Dept. Health & Human Services 

6.  Work through the HIPAA Module at this site: 
          UTMB Dept. Pediatrics, HIPAA Curriculum

Submission

Instructions:
1.  We suggest you answer these questions in Word , then cut and paste into an e-mail (rather than submit responses in the body of the email.


2.  Submit answers by e-mail to Course Directors  (Gayani Silva, MD, gsilva@utmb.edu and Virginia Niebuhr, PhD, vniebuhr@utmb.edu )  

 
3.  IMPORTANT NOTE:  this module only must also be sent to the ACS Coordinator, Sommer Madrigal slmadrig@utmb.edu.

Due by Friday of Week 3

Billing & Documentation
 1.  What is a CPT code?   What is the most suitable CPT code for Christina?  What is an ICD code? what is the most suitable ICD code given Christina's diagnosis?

2.  How do 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, so she cannot bring him in for a visit.  Explain why you would or would not write your patient’s prescription with a refill option? 

 Insurance and Payment

5.  What groups of children likely do not have insurance? 

6.  What groups of children likely do not have insurance eligibility? 

7.  In the community in which you are completing the ACS,  what are the healthcare options for uninsured children?

8. What are the differences between Medicaid vs Chip insurance?  Where does the money come from to fund these programs?

9.  What insurances are accepted in this community practice?

10. Costs: 

a  What is the charge for well-visit in this practice? (i.e. what would a patient pay out-of-pocket with no insurance?)

 

b,  What will the co-pay be for Christina's visit if she has Medicaid?  CHIP?


c.  What will be the probable reimbursement?  does this vary, depending on the insurance coverage.

HIPAA - Health Information Portability & Accountability Act

11.  When the physician communicates with a specialist regarding the patient’s care, is it necessary to first get the parent's written authorization?

12.  Given HIPAA rules, what are some possible issues with electronic data and technology (electronic medical records,  iPhones,  emails)?

 

13.  What steps can you see in this practice that show evidence that the HIPAA Privacy Rule is being followed?

 
site developed 6-04
last update: 10-22-12

contact:  V. Niebuhr. vniebuhr@utmb.edu.