A computer program called RAT-STATS is the primary statistical ...

[lunatika]

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:
  ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________

[nathang24]

Answer to Question 1

Answer: F

Answer to Question 2

______Bill workers' compensation insurance
______Bill healthcare insurance
__X___Bill both for separate issues
Justification: The knee injury is most likely workers' compensation; those charges should go to workers' compensation. The fever may or may not be related to workers' compensation, so billing the healthcare insurance for the blood draw is best. If students say workers' compensation and justify that they should wait for workers' compensation to reject the charges related to the fever, this could also be correct.

[lunatika]

YES! Correct, THANKS for helping me on my review

[aliotak]

Thanks for the timely response, appreciate it