Most healthcare insurance plans require that every planned hospital admission or outpatient procedure be pre-certified. This means that the physician's office on behalf of the patient has contacted them with information about the patient's condition and their plans for treatment. The purpose for this contact is so that the insurance company authorizes the treatment for payment. In this assignment, you will be conducting this pre-certification authorization for three patients that need a tonsillectomy/adenoidectomy procedure performed. You will need to open the PDF file in this module to complete this assignment. In this PDF file you will find the pre-certification criteria and the history and physical for the three patients. The criteria is triggered by the patient's diagnosis. For example, if a patient has been diagnosed with Obstructive tonsillar hypertrophy, then criteria 400 will apply. In criteria 400, all three indicators (410 Symptoms (Sx)/findings; 420 3+/4 tonsillar enlargement by physical exam (PE); and 430 Normal palate by PE) must be met for approval. Under the indicator 410 Sx/findings - one item in 411-415 must be present, and if the indicator is 415 - one item list under 415, -1 Weight loss, -2 Failure to thrive, or -3 Dysphagia with solids must be present. Using the Pre-cert criteria and patient histories, compare the three patient's histories to the criteria for tonsillectomy/adenoidectomy. Determine if the patient should be approved for the procedure or not. Submit a summary page to your instructor for grading that includes: the patient number, which criteria you used for each patient (eg. 200 Chronic Tonsillitis) and then identify the specific criteria that the patient met (eg. 211 Throat pain and 212-4 Documented increase in tonsil size) or explain why the patient did not meet the criteria for the procedure.

In this Discussion, you outline the workflow issue (Incomplete Medication Reconciliation)you plan to use for Part 1 of the Course Project in order for your colleagues to provide their perspectives and feedback. This Discussion serves as an opportunity for you to refine you workflow issue before submitting Part 1 of the Course Project in Week 5. It also builds on the Week 3 Discussion, which provided you with general information about meaningful use and its ties to common workflow issues in health care. You will apply that knowledge in this Discussion by critically analyzing your colleague's selected workflow issues, which will assist you in gaining a stronger grasp of the Course Project.The Instructor in this course will also respond to your preliminary workflow issue and provide guidance for any necessary revisions or refinements you should make to better meet the requirements for the Course Project.To prepare:Reflect on the workflow issue that you are planning to use for Part 1 of your Course Project (Incomplete Medication Reconciliation). Consider the inefficiencies and gaps based on your preliminary knowledge about the workflow.Examine how the workflow issue (Incomplete Medications Reconciliation) relates to electronic health records (EHRs). How could the workflow issue be addressed through either the implementation or optimization of an EHR system?Identify one or more specific meaningful use objectives that connect to your workflow issue (Incomplete Medication Reconciliation). Refer to the Learning Resources in Week 3 for a review of the meaningful use objectives.Review your initial thoughts on how you will conduct a gap analysis (your Gap Analysis Plan paper). What information will you need to obtain about the current-state workflow? How will you gather this information, and who will you consult in your organization?With these thoughts in mind:Post by 6pm today, a minimum of 550 words essay in APA format and a minimum of 3 references which include the level 1 headings as numbered below:1) A description of the workflow issue you plan to use for your Course Project. The workflow issue I plan to use is "Incomplete Medication Reconciliation".2) Describe where the inefficiencies lie based on your current knowledge about the workflow, and identify the meaningful use objective(s) related to the workflow issue. (read Meaningful Use stage 1 & 2 on medication reconciliation)3) Provide a brief overview of your plans for conducting a gap analysis, including your data-collection methods and who you will contact in the organization.