You have been hired by a large physician practice to assign office visit and professional services coding. Very early on you realize that component services are routinely billed with modifier 59 regardless of the documentation.
The office manager is not familiar with general coding guidelines. Her main concern is that claims are submitted timely. Her initial response is, “I do not care how you get it done; if there is an edit do whatever the system tells you to move the claim forward.” The providers also appear to show little interest in the documentation guidelines.
What is your responsibility in this situation?
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I need 2 pages
Attached below is a document about modifier 59
Guidelines for paper are attached below
Critical Thinking Case Study Guide
The Assessment Rubric for Critical Thinking (ARC) Assessment Profile is a written demonstration of your competence to analyze, synthesize, and evaluate a problem and create a bridge between theory and application.
A successful ARC project will demonstrate your capacities to examine, question, critique, modify, and reflect on a healthcare informatics issue associated with the electronic health record. This will include utilizing your critical thinking skills to intellectually explore and critically examine a problem/issue, develop a perspective on this problem/issue and provide support in favor of your perspective.
There are six major goals within the ARC Assessment Profile. They are: Communication, Analysis, Problem Solving, Evaluation, Synthesis, and Reflection.
| ARC Assessment Profile | |
| Goal 1: | Communication: Define the problem in your own words. |
| Questions: | a. Identify the main idea or problem in the case study b. Support your choice of the main idea or problem with details and examples. c. Organize your findings (details & examples) in a logical and coherent format. |
| ARC Assessment Profile | |
| Goal 2: | Analysis: Compare & contrast the available solutions within the scenario . |
| Questions: | a. Identify 2 – 3 possible solutions for the issue and/or problem. b. Compare and contrast the pros and cons for each solution. c. Choose one solution you believe is the best one for addressing/solving the issue and or problem. |
| ARC Assessment Profile | |
| Goal 3: | Problem Solving: Select one of the available solutions and defend it as your chosen solution. |
| Questions: | a. Defend your chosen solution. b. Back up your choice through facts and or evidence that support your solution. |
| ARC Assessment Profile | |
| Goal 4: | Evaluation: Identify the weaknesses of your chosen solution. |
| Questions: | a. Identify any areas of weakness within your chosen solution. b. Identify hidden assumptions and beliefs you may harbor about your choice of solution. |
| ARC Assessment Profile | |
| Goal 5: | Synthesis: Suggest ways to improve/strengthen your chosen solution (may use information not contained within the scenario). |
| Questions: | a. Identify concepts and ideas from multiple sources that improve or strengthen your solution. b. Identify any new found information and the impact that new information may or may not have on your solution. c. Identify potential missing information and the impact that missing information may or may not have on your solution. |
| ARC Assessment Profile | |
| Goal 6: | Reflection: Reflect on your own thought process after completing the assignment. |
| Questions: | a. Identify the strengths and weaknesses in your thought process with this project. b. Where there bias’ in your thinking? c. What did you learn from doing this project? d. What would you do different next time to improve your critical thinking skills process? |
