Review the following cases and determine the CMS-prescribed billing order for each. EXAMPLE: Example: Patient is retired and covered by Medicare, an employer-sponsored retirement plan, and his spouse’s employer-sponsored large group plan.

Billing Order: Employer-sponsored large group plan, Medicare, employer-sponsored retirement plan

1. Medicare as Secondary Payer: The patient has Medicare and an employer-sponsored retirement plan, and the patient is a dependent on the spouse's employer-sponsored large group plan. The claim is for an injury received in a car accident.

Billing order:

2. Medicare as Secondary Payer: The patient is 67, working full-time, and covered by Medicare, an employer-sponsored large group plan, and a Medigap plan. The spouse is retired, 62, and covered by an employer-sponsored plan for 18 employees.

Billing order:

3. Medicare as Secondary Payer: The patient is 50 and disabled and has Medicare and an employer-sponsored group health plan that covers 50 employees.

Billing order:

Why do you think people write one way and speak to people a different way?

Mr smith a 52 year old patient, is admitted to the coronary care unit with the diagnosis of acute inferior myocardial infarction. the patient has a history of smoking two packs of cigarettes for 35 years, and he drinks a six pack of beer on weekend nights, but does not drink the rest of the week. he is the sole financial support for his family. he is a consultant for a company and is out of town during the week days. mr smith has gained 20 pounds. he is 5 foot, 6 inches, weighing 200 pounds. his diet consists mostly of fast foods. he rarely exercise. his wife care for their three teenage children. the eldest son, 17 years of age, totaled the family car when drinking and driving 2 days ago and he is in the local children’s hospital in the intensive care unit in critical condition. mr smith developed chest pains and slumped over in his chair during an argument with his wife about their teenage daughter, who is 15 years of age and wanted to get birth control pills. the wife is in the waiting room while the nurses settle mr smith into his room. the youngest son, 13 years of age, is at a friends house. the teenage daughter is staying at the bedside of the criticall i’ll eldest son. the wife blames her eldest son for her husband’s heart attack and told the emergency department nurse that she does not care to see her son i’ll. a. what maladaptive response to stress may have contributed to mr smith’s development of an illness b. based on the case study, what family assessment data may be used to determine coping strategies being currently used by the family. c. what nursing interventions should be used to promote effective coping for the patient and his family?

How can an advanced nurse or aprn improve access and health outcomes for marginalized populations and communities? what individual knowledge, skills , and attitudes are necessary to improve health inequities?