Identify and explain the circumstances in which separate ...

[penguins]

Identify and explain the circumstances in which separate allowances are warranted for pre-operative services.
 
  What will be an ideal response?

Question 2

What is considered a rehabilitation benefit? Explain work hardening programs and their relationship to such benefits. Discuss vocational rehab as well.
 
  What will be an ideal response?

[raili21]

Answer to Question 1

Answer:
The immediate preoperative visit in the hospital or elsewhere is generally necessary to examine the patient, complete the hospital records, and initiate the treatment program. Charges for these procedures are included in the surgical allowance. However, a separate allowance may be warranted for preoperative services in the following circumstances:
a. When the preoperative visit is the initial visit (i.e., in an emergency room), and prolonged detention or evaluation is required to prepare the patient or to establish the need for the surgery.
b. When the preoperative visit is a consultation. Be sure the physician has not up coded a preoperative visit to increase benefits. An example is a surgeon billing for a consultation prior to surgery when in fact the visit was a simple preoperative visit.
c. When procedures that are not usually part of the basic surgical procedure (i.e., bronchoscopy prior to chest surgery) are provided during the immediate preoperative period.
d. When a procedure could normally be performed in the office, but under certain circumstances requires hospitalization.

Answer to Question 2

Answer:
If an employee is found to have a permanent disability, some states allow for a rehabilitation benefit. This benefit can be provided to retrain the employee in a physical ability which will help him to seek future employment.
Some states participate in a work hardening program, wherein an employee is assigned therapy similar to their work in an attempt to strengthen them and build up their endurance toward a full day's work. Often employees in such a program will be returned to work on a limited or restricted basis. Physicians, therapists, employers, insurance carriers, and all others concerned with the employee's case must keep in constant communication to ensure that the patient is not returned to work either sooner or later than possible.
Many states also allow for vocational rehabilitation or retraining in a different job field when the employee is unable to return to his former position. This can include courses in colleges and vocational schools, or on-the-job training programs. Often employees are paid a weekly allowance while they are attending school and for a limited time after graduation. The time after graduation is to allow them time to locate a job. The employee is then considered to be off temporary disability and returned to work. Vocational rehabilitation can also include job guidance, resume preparation, and placement services.