A computer program called RAT-STATS is the primary statistical tool for the HMO's Office of Audit Services.
Indicate whether this statement is true or false.
Question 2
For each of the partial physician notes below, determine if the situation warrants a workers' compensation claim versus a claim to the patient's insurance provider. Indicate the correct choice and write a justification for your answer.
Physician Note
S: 56-year-old female mail carrier came to the office today for a sore knee. Patient states she slipped on the ice while working yesterday and hit her knee. Reports aching pain to right knee that hurts most when she is walking.
O: Patient knee is swollen and bruised, consistent with falling and hitting it. ROM is full with tenderness, but not consistent with ligament damage. Patient has temperature of 102F; all other vital signs are WNL.
A: Bruised knee, doesn't appear to have torn ligaments; rule out fracture.
P: X-Ray and then refer to PT for consult if no fracture, CBC to check for possible infection due to fever.
______Bill workers' compensation insurance
______Bill healthcare insurance
______Bill both for separate issues
Justification:
___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________
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