Author: Judy

In not less than 200 words discuss the follow:

You have learned about the liability of MCOs (managed care organizations) such as HMOs (health maintenance organizations) and PPOs (preferred provider organizations). Thinking about the information in Chapter 6 on 

 Title: The Law of Healthcare Administration 

Edition: 8th (2017) 

Author: Showalter 

Publisher: Health Administration Press Book 

ISBN: 978-1567938760  

where does the liability lie for the managed care organization when the MCO personnel make decisions about insurance coverage for hospital stays?

Please do not limit your analysis to length of stay, but consider other scenarios associated with MCO decision making such as approval or denial of medically necessary treatment (or limitations of treatment) as well, and share your scenarios with the class. Defend your response thoroughly and include the potential liability implications. Lastly, discuss the options, if any, MCO or PPO plan members have when denied coverage for medically necessary care.

In two different paragraph with no less than 100 words give your personal opinion to and Marivette Bedoya 

 Sharon Buchanan 

Since the mid-1990s, forty-seven states have established a patient bill of rights that attempt to protect against managed care abuses. One of the primary obstacles to federal enactment has been uncertainty over the consequences of increasing MCOs’ liability exposure (Mariner, 2016).  State’s statutes on managed care liability are not consistent or clear about which forms of direct or vicarious liability are included. The statutes give an individual the right to sue MCOs for wrongful actions that cause personal injury, however these statutes target narrower or broader ranges of managed care activities. Most statutes are not clear about which forms of direct or vicarious liability they might include.  Direct liability is when the MCO is the primary wrongdoer and vicarious liability holds MCOs secondary liable for errors made mostly by treating physicians.  Managed care liability statutes also vary in the preconditions for bringing suit. California, Georgia, New Jersey and Washington limit suit to patients with serious injuries and California, Georgia, New Jersey and Texas require that external review channels be pursued prior to suing for damages (Mariner, 2016).

The Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization’s negligence. ERISA prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Attorneys are unwilling to file suits based on coverage denials because leading ERISA preemption rulings have not yet been overruled (Hall & Agrawal, 2003).

When denied coverage for medically necessary care, MCO or PPO plan members must go through levels of appeals, which are reviewed by their insurance company. After the appeal process, the member can take his case to an independent review board and/or litigation.  The review board is a group of medical professionals who are not affiliated with insurance companies, nor do they have any fiscal bias as to whether or not claims are paid or denied. Generally, this is where medical necessity denials appeals are given the full, fair, and objective review that families and patients deserve; and conversely, where we see the most denials overturned (2019).

References

Hall, M. A., & Agrawal, G. (2003). The Impact of State Managed Care Liability Statutes. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.5.138.

Mariner, W. K. (2016, June). Liability for managed care decisions: The Employee Retirement Income Security Act (ERISA) and the uneven playing field. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380409/

Medical Necessity Criteria: Denials Management. (2019, January 21). Retrieved from https://fixmyclaim.com/medical-necessity-criteria/.

 Marivette Bedoya 

Managed care organizations where created to intend to reduce unnecessary healthcare cost through the use of patients being able to select care in terms of affordable costs and physician economic incentives (Showalter, 2017). Managed care organizations have a main focus for more preventative and primary care. Within managed care organizations lie health maintenance organizations and preferred provider organizations to provide the best care at minimal costs. 

Due to managed care organizations placing requirements on physicians to take on more responsibilities with less patient referrals to specialists, an increase of suit are linked to the growth in managed care. With managed care organization personnel making decisions, physicians are often caught in the middle toward their responsibility to the patient and to the obligation to the managed care organization about insurance coverage for hospital stays. However, working under managed care organization personnel doesn’t not necessarily make them non-liable. 

There is an Employee Retirement Income Security Act that protects managed care organizations from liability when they are part of an employee group health plan affiliated with the Employee Retirement Income Security Act. The Employee Retirement Income Security Act does not allow negligent claims to be made against the Employee Retirement Income Security Act health plans for injuries (Hall & Agrawal, 2003).

References: 

Hall, M. A., & Agrawal, G. (2003). The Impact of State Managed Care Liability Statutes. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.5.138.

Showalter, J. S. (2017). The law of healthcare administration. Chicago, IL: Health Administration Press.

The post HA525 Unit 3 Discussion appeared first on Splendidwritings.com.

Unit III Article Review

Locate one article in the Waldorf Online Library that addresses the topic of sacred Buddhist texts in connection with Buddhist involvement in social and political issues. Write a review of the article that includes the following elements:

 Summary of Article

 Analysis of connection between article’s main points and description of interpretation and exegesis in unit lesson

 Evaluation of the article’s conclusion and supporting reasons

Your paper should be at least two (2) pages, not including the title or references pages. APA formatting must be used throughout.

The following are a few journals that you might find useful in your research of the topic. (This is not a complete list, and you certainly may use an article from another academic journal.) These are all located in Academic Search Complete database.

 Buddhist-Christian Studies

 International Journal For Philosophy of Religion

 Interdisciplinary Journal of Research on Religion

 Sociology of Religion

 Method & Theory In The Study of Religion

 Journal of Contemporary Religion

 Reviews in Religion & Theology

Please contact your librarian if you need additional help locating an article. The librarians’ contact information can be found on the right side of the online library page.

Information about accessing the Blackboard Grading Rubric for this assignment is provided below

The post Religion Article Review appeared first on Splendidwritings.com.

The test results are in the attachment to help write this paper.

Submit your 2- to 3-page Individual Reflection. Your Individual Reflection must:

1. Summarize the results of the “Personality Test” and state whether you agree with the results. Provide a rationale to support your conclusion.

2. Assess how your personality influences how you lead and how you follow. Draw on your professional and personal experience to provide examples.

3.Analyze how you, as a follower, can contribute to effective leadership in a business organization. Provide an explanation to support your analysis.

4.Analyze how you, as a leader, can encourage effective followership in a business organization. Provide an explanation to support your analysis.

5. Finally, select one personal quality you would like to improve to become a more effective leader and follower. Provide a justification as to why this improvement would be a benefit to you and an organization.

The post How your personality influences to become a effective and professional leader. appeared first on Splendidwritings.com.

Select a state or federal law or regulation related to patient safety that has been implemented within the last five years requiring hospitals or any other health care organizations to change the way they manage the delivery of care. Discuss the changes that have occurred because of this law or regulation.

Additionally, discuss the technology associated with either your selected law/regulation or a similar one. Are there ethical dilemmas that have resulted from technology changes when delivering care to patients or patient safety? Explain the dilemmas and how they might be resolved.

The post federal law or regulation related to patient safety appeared first on Splendidwritings.com.

Open and read the Current Code:
APA’s Ethical Principles of Psychologists and Code of Conduct – PDF (223 KB) At the NU Library, research an academic article (i.e. peer-reviewed) of a scientific experiment with human subjects that would VIOLATE CURRENT APA ETHICAL STANDARDS Briefly summarize your experiment in a post. Include a summary of the study itself (topic, method, results) as well as why you think this study is unethical Now listen to the following podcast:
Trust engineers – MP3 (30.5 MB) and discuss whether or not Facebook was conducting unethical research, and how you personally feel as a potential research subject Finally, be sure to respond to two other’s posts throughout the week Your post should: -Explain why your experiment would be considered unethical by today’s standards
-Maximum two pages
-Provide APA style reference (Author, Year Published, Title of Article, Journal Name)
-Use your own words (i.e. no quotes and do not plagiarize)
-Provide a 1-2 page summary of the study, what ethics code violation you believe occurred, as well as any valuable findings from the study, in addition to your response to the Facebook research.  This summary should be posted to the discussion board NO LATER than WEDNESDAY OF WEEK 1
– Provide a research post and a minimum of two (2) posts to other students’ posts. Please, no more than four (4) posts to others
-Threaded discussions are designed to enhance your critical thinking and research skills. Your posts should be dispersed throughout the week.

Please refer to your course outline for more information concerning this assignment.

The post How has research on human subjects changed? appeared first on Splendidwritings.com.

Need 2 nursing post done. Please make sure you answer every question.

Requirements (FOR EACH POST****)

· 350 words min

· 1 scholarly source *less than 5 years*

· APA format

POST 1

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:

Sodium (Na+)

156 mEq/L

Potassium (K+)

4.0 mEq/L

Chloride (Cl–)

115 mEq/L

Arterial blood gases (ABGs)

pH- 7.30; Pco2-40; Po2-70; HCO3-20

Normal values

Sodium (Na+)

136-146 mEq/L

Potassium (K+)

3.5-5.1 mEq/L

Chloride (Cl–)

98-106 mEq/L

Arterial blood gases (ABGs)

pH- 7.35-7.45

Pco2- 35-45 mmHg

Po2-80-100 mmHg

HCO3–22-28 mEq/L

1. What is the etiology of Diabetic Ketoacidosis?

2. Describe the pathophysiological process of Diabetic Ketoacidosis.

3. Identify the hallmark symptoms of Diabetic Ketoacidosis.

4. Identify any abnormal lab results provided in the case and explain why these would be abnormal given the patient’s condition.

5. What teaching would you provide this patient to avoid Diabetic Ketoacidosis symptoms?

POST 2

A three-month-old baby boy comes into your clinic with the main complaint that he frequently vomits after eating. He often has a swollen upper belly after feeding and acts fussy all the time. According to his parents, the vomiting has become more frequent this past week and he is beginning to lose weight. After careful history taking, a thorough physical exam and diagnostic work-up, the patient is diagnosed with pyloric stenosis.

1. What is the etiology of pyloric stenosis?

2. Describe in detail the pathophysiological process of pyloric stenosis.

3. Identify hallmark signs identified from the physical exam and presenting symptoms. What diagnostic tests would help to confirm the diagnosis of pyloric stenosis?

4. Describe the pathophysiology of complications of pyloric stenosis.

5. What teaching would you provide this patient/parents regarding pyloric stenosis?

The post 2 Nursing posts need done in 18 hours appeared first on Splendidwritings.com.

Ethics of Human cloning in the field of biotechnology. 100 words discussion.

The post Ethics of Human cloning in the field of biotechnology appeared first on Splendidwritings.com.

In your opinion, for most immigrants traveling into the United States during the late 19th century, was the ideal of the “American Dream” an achievable goal?

Please include the name of the person or question to which you are replying in the subject line. For example, “Tom’s response to Susan’s comment.”

ALSO PLEASE REPLY TO ANOTHER STUDENTS COMMENT BELOW 

Morgan:

I feel that the “American Dream” was not an achievable goal for all immigrants. Upon arrival to the United States, these immigrants were accepted as citizens of the United States of America, but were not seen as citizens by the people who already resided here. Industrial jobs were booming at the time, but workers were underpaid compared to the labor performed during these jobs. Since these minorities were seen as outsiders during this time, I feel that it was very difficult to live the same type of lifestyle lived by those who were born and raised. Many immigrants did beat the odds, though and become very successful, and eventually ended up bringing their families to reside in the United States as well!

The post American History II appeared first on Splendidwritings.com.

Develop a 3-5 page outline of concepts you would like to apply to your own life and identify relevant scholarly sources that will help you with your application of concepts.
As you may have noticed as you have worked through earlier assessments, Sociology is applicable to our everyday lives. We can oftentimes take a sociological concept and use it to explain something that occurs in our own lives. For example, you have learned about norms and how we tend to follow the norms of a society. You can use that to explain how people behave when they are in an elevator. Most people face forward, look up at the numbers, and don’t talk.
Many of your experiences can be analyzed using sociological concepts. For your final assessment, Assessment 6, you will complete a Sociology of Me and apply many of the concepts you have learned about in this course to your own life. For Assessment 5, begin to think about which concepts you would like to apply to your own experience, develop an outline, and identify appropriate resources. In order to complete this assessment, you will need to show your understanding of some additional concepts related to social structure, education, and technology/media.
We have learned how a society’s culture can influence people. There are other elements in society, however, that also affect our decisions and behavior. Sociological research has found that in addition to culture, social structure and groups also significantly impact many of our individual choices. Our position in the social structure affects our behaviors, attitudes, and ideas. For example, an important element of social structure are groups. We belong to a variety of different groups. Decades of research have documented the impact of group conformity on the individual. Although people tend to often believe that they act as individuals and aren’t impacted by others, research has found this is usually not the case. The Milgram experiment in your Resources is a great example. Milgram (1963) examined conformity and obedience and found that people are highly influenced by authority and the demands of conformity, even to the point that we will inflict pain on another person to obey authority.
Sociologists also study education and how it is impacted by a society’s culture and structure. The purpose of education is to provide knowledge (facts, skills, cultural norms) to members of a society. In the United States, education teaches us not just skills, but also how to be effective citizens. Education transmits the dominant culture, ensuring that children understand cultural norms and values. Educational attainment impacts life outcomes—it affects our occupation, earnings, work conditions, and health. Thus, education is related to social inequality. We have a tendency to assume that education is an equalizer in the United States, but this is something that is debated by sociologists. Is education equally available to everyone? Studies suggest it is not. Social class can impact the quality of school children attend, what they study, and how many years they attend school. Many students graduate from college with significant student loan debt. How might someone’s experience after college graduation be different if they graduated from college debt-free because their parents could afford to pay for it?
We regularly see new products and services as a result of increasing technology. We often take the influence of technology and media for granted, but it has a substantial impact on how we understand our culture and society as a whole. Many new products and services are a response to society’s changing needs. But technology can also serve to shape the values held by a society. Think about how our interaction has changed in the past ten years as a result of technology. Has that impacted our values? A small number of corporations deliver Internet platforms and a small number of corporations produce most of our media. What impact does that have on our access to technology and information?
Reference
Milgram, S. (1963). Behavioral study of obedience. The Journal of Abnormal and Social Psychology, 67(4), 371–378.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Examine how theory and sociological concepts apply to everyday life.  Identify sociological concepts that affects my field of study (NURSING) Competency 2: Explain the basic tools of sociological inquiry.  Identify resources to support analysis from a sociological perspective. Competency 4: Analyze the influence of culture on both the individual and society.  Explain the relevance of concepts to sociological topics. Competency 6: Compose text that articulates meaning relevant to its purpose and audience.  Develop text using organization, structure, and transitions that demonstrate understanding of cohesion between main and subtopics.  In this assessment, you will create an outline for Assessment 6, The Sociology of Me. The outline should identify concepts you will be using to analyze your own experiences and provide a brief summary of why each concept may be relevant. Your sociological analysis of yourself should be supported by credible, scholarly sources, such as those from academic journals. As such, you will also identify scholarly sources that you intend to use.
Deliverable
Write an essay in which you complete all of the following:
Part 1: Section Outline
Identify the sociological concepts you plan to discuss in each section. Briefly explain the relevance of each concept. Sections need to include:
Culture and Socialization.  Examine the impact culture and socialization has had on your life. Examples of concepts to include: Socialization, agents of socialization, culture, values, language, norms, subculture, counterculture, ethnocentrism, and cultural relativism. Social Structure and Groups.  Analyze the impact of social structure and groups on your life. Examples of concepts to include: Social structure, hierarchy, power, bureaucracy, role, status, primary groups, secondary groups, and group think. Education.  Explain your educational experience from a sociological perspective. Examples of concepts to include: Hidden curriculum, tracking, social stratification, and stereotypes. Professional field.  NURSING Explain sociological issues that affect your field of study. All concepts from other sections are relevant. Technology and Media  Analyze the role of technology and media in your everyday life. Examples of concepts: Media, digital divide, framing, and social change. Part 2: Identify Preliminary Supporting Resources
Identify resources to support an analysis from a sociological perspective.  At least one scholarly source should be identified for each section above. Provide a brief summary of each identified source. Additional Requirements
Written communication: Develop text using organization, structure, and transitions that demonstrate understanding of cohesion between main and subtopics. Written communication is free of errors that detract from the overall message. Sources: Cite at least five scholarly sources. Length: 3–5 pages, not including title and reference pages. Format: Include a title page and reference page. Use in text citations to cite your sources. [Example: Writing becomes better as the child matures (Britton, Thomas, & Miller, 1996).] Font and size: Times New Roman, 12-point.

The post 1000-5 appeared first on Splendidwritings.com.

Review the Summers text, pp. 71–75. Choose two hypothetical practice situations under “Ethically, What Went Wrong?” You will respond to two chosen ethical situations with a detailed, well thought-out post. You should try to choose situations that have not been chosen by your colleagues. 

Post the number associated with your chosen situation and a brief description. Then answer the following questions: What was done in your chosen situations that was unethical? What is at least one example for each situation of how the person acting unethically could have handled the situation more ethically? Please be specific and support your conclusions by citing the course resources AND at least ONE peer-reviewed resource (i.e., journal article, professional organization website, etc.).

Resources:

Summers, N. (2016). Fundamentals of case management practice: Skills for the human services (5th ed.). Boston, MA: Cengage Learning.Chapter 2, “Ethics and Other Professional Responsibilities for Human Services Workers” (pp. 33–76)Chapter 4, “Cultural Competence” (pp. 95–115)Chapter 5, “Attitudes and Boundaries” (pp. 117–138

)Read the entire code of ethics for the professional organization to which you most closely align (pp. 19–20 of Evans, Hearn, Uhlemann, & Ivey). If you are not sure which organization’s code of ethics to select, please review the National Organization for Human Services ethical standards, available at http://www.nationalhumanservices.org/ethical-standards-for-hs-professionals

The post Ethically, What went wrong? appeared first on Splendidwritings.com.