There is no better nurturer than Mother Nature and some of the finest products that are used by people in their daily lives come from nature. One of the reasons why our ancestors lived a far healthier life and were plagued by far less health problems was because of the absence of manufactured products and the use of natural ingredients. From beauty to health, nature is abundant with products that cater to all our needs. Another gift of nature is Ayurveda, a 5000 year old system of natural healing that originated from India and is the most oldest and scared healing science. The word Ayurveda translates to lifespan built on knowledge and that is exactly what it is, knowledge acquired by the ancient people that is very effective in the treatment of various diseases till date. In the present times when medicines are becoming a health problem rather than a boon, more and more people are turning to Ayurvedic medicines for a safer and healthier solution to health problems. There are various reasons why Ayurveda is a better option over allopathic medicines:
Ayurvedic treatment provides a permanent solution: Unlike other medicines that do not fall in tune with the proper requirements of the body and at times are used like crutches by patients, Ayurveda studies the requirement of very person and provides medication accordingly. It does not merely mask the issue but goes to the root cause of the problem and works at eliminating the cause of the disease. This is why it is a more detailed healing system as it requires the careful study of a patient, their physical and emotional characteristics and provides a holistic treatment that encompasses their physical, mental and emotional health.
It is safe and natural: Most medicines are made up of chemical compound that do more damage than good in the long run. Often enough we find that people start to grow dependent on these medications and that wrecks their organs like liver, kidney or heart. With Ayurveda, all these worries can never materialize as being a nature based medication; they have absolutely no side effect and are safe. They can easily be used for a long period of time by anyone without any worries of ill effects that other medicines pose.
Cost effective: Anyone who has had to pay hospital bills in the past few years would know that getting treated for any ailment can burn a large hole in the pocket. Paying the piling bills can be more worrisome than the actual illness itself and can take a toll on the mental health but Ayurveda on the other hand is far less cheap. One can easily use Ayurvedic medicines for a long time without worrying about price.
The new informational modifier could affect payment, too.
To facilitate claims processing for disaster victims, the Centers for Medicare and Medicaid (CMS) has create a new modifier CR (Catastrophe/disaster related) that you can use if you ever need to code services for patients affected by catastrophe/disaster. This article will familiarize you with modifier coding guidelines and get you key pointers on when, where and why you should use this disaster modifier.
When to Report Modifier CR
Note that you will not be able to report the modifier for all disaster related services - in fact there are some definite factors that must be met prior to using this modifier. For one, you can use this modifier only in visibly catastrophe/disaster situations.
Section 1135 of the Social Security Act empowers the HHS to modify/waive certain Part B Medicare, Medicaid, Children's Medicaid, and HIPAA requirements. The department allows these waivers in order to better track how payers process claims in uncertain circumstances. Caution: These two events need to take place for the HHS to raise the 1135 waiver and for you to use the newly-introduced modifier.
• First, the president must declare an emergency/disaster under Stafford/National Emergencies act.
• Secondly, HHS secretary must announce a Public Health Emergency under the Public Health Service Act. Some recent declarations include floods in North Dakota, Hurricane Sandy in New York and New Jersey, just to mention a few.
Type of Disaster The scenarios mentioned above involve weather, however you can use modifier CR for any type of disaster, be it for explosions, mass shooting or anything that would meet the criteria for a waiver under section 1135. As soon as the president and secretary make the waiver official, you should report the disaster modifier along with any services for patients impacted by these catastrophes.
Twin Purpose for the New Modifier The new informational modifier CR could also affect payment. While CMS uses this modifier to identify claims that are conditioned by a formal Section 1135 waiver, the government uses it to streamline process claims in disaster and catastrophe situations. Tip: Append the modifier for established victims of catastrophe or disaster. This is particularly to safeguard yourself against denials for not using modifier CR in catastrophe/disaster area.
This is a short article looking at assisting with intubation. Ensure you have a good knowledge of what all devices are called so to avoid confusion if the anaesthetist or paramedic asks for a certain device. Lay out all devices required in a sterile environment so they are ready at hand when needed. Ensure you have a range of sizes for the different tools available, e.g. size 7, 8, 9 ET tubes, size 3, 4 laryngoscope blade. Place the items to the side of the operator if you are required to do chest compressions, or be at hand ready to pass over items when required. Ensure there is a Bougie or Introducer at hand in case of a difficult intubation. If these items are used be prepared to assist in feeding the ET over them so that they can be placed in the airway.
Consider whether the patient will be a difficult intubation, do they have excessive features like a large tongue or neck. Is there evidence of airway obstruction where suction or forceps may be required to remove the debris. If there is no obstruction and the health care professional is finding it difficult to intubate, consider assisting in positioning of the
Airway bag
patient and conducting airway/intubation manoeuvres (if you are not actively conducting CPR).
Consider whether there is an object such as a pillow in the vicinity where you could place it under the patients' neck to provide some better sight alignment of the airway (ensure the patient has no c-spine compromise before doing this). If able to do so, consider a jaw thrust manoeuvre or lifting of the chin to aid in opening up the airway and providing better sight. Consider the BURP (Backwards Upwards Right Pressure) manoeuvre, place some fingers on the trachea and apply some pressure in the 'BURP' order. The health care professional may direct you where to apply further pressure with what they can visualise.
You can use the Sellick manoeuvre where there is risk of the patient vomiting whilst being intubated. Locate the cricoid cartilage and apply pressure towards the oesophagus. The idea is to collapse the oesophagus so no vomit can pass through the passageway. Use judgement when applying pressure and be cautious if querying a c-spine injury.
Once the intubation process is complete have a 20ml syringe filled with air ready for the health care professional to inflate the cuff. You may need to assist in holding the stethoscope head when auscultating the patient for tube placement confirmation. Once the tube is confirmed and tied in place, attach a catheter mount and CO2 device. Confirm the presence of CO2 and begin ventilating the patient. If in a cardiac arrest scenario, you can now provide continuous ventilations. Move any of the unused equipment a safe distance away where it doesn't get in your way but is close enough to grab again if needed.
Ayurvedic treatment provides a permanent solution: Unlike other medicines that do not fall in tune with the proper requirements of the body and at times are used like crutches by patients, Ayurveda studies the requirement of very person and provides medication accordingly. It does not merely mask the issue but goes to the root cause of the problem and works at eliminating the cause of the disease. This is why it is a more detailed healing system as it requires the careful study of a patient, their physical and emotional characteristics and provides a holistic treatment that encompasses their physical, mental and emotional health.
It is safe and natural: Most medicines are made up of chemical compound that do more damage than good in the long run. Often enough we find that people start to grow dependent on these medications and that wrecks their organs like liver, kidney or heart. With Ayurveda, all these worries can never materialize as being a nature based medication; they have absolutely no side effect and are safe. They can easily be used for a long period of time by anyone without any worries of ill effects that other medicines pose.
Cost effective: Anyone who has had to pay hospital bills in the past few years would know that getting treated for any ailment can burn a large hole in the pocket. Paying the piling bills can be more worrisome than the actual illness itself and can take a toll on the mental health but Ayurveda on the other hand is far less cheap. One can easily use Ayurvedic medicines for a long time without worrying about price.
The new informational modifier could affect payment, too.
To facilitate claims processing for disaster victims, the Centers for Medicare and Medicaid (CMS) has create a new modifier CR (Catastrophe/disaster related) that you can use if you ever need to code services for patients affected by catastrophe/disaster. This article will familiarize you with modifier coding guidelines and get you key pointers on when, where and why you should use this disaster modifier.
When to Report Modifier CR
Note that you will not be able to report the modifier for all disaster related services - in fact there are some definite factors that must be met prior to using this modifier. For one, you can use this modifier only in visibly catastrophe/disaster situations.
Section 1135 of the Social Security Act empowers the HHS to modify/waive certain Part B Medicare, Medicaid, Children's Medicaid, and HIPAA requirements. The department allows these waivers in order to better track how payers process claims in uncertain circumstances. Caution: These two events need to take place for the HHS to raise the 1135 waiver and for you to use the newly-introduced modifier.
• First, the president must declare an emergency/disaster under Stafford/National Emergencies act.
• Secondly, HHS secretary must announce a Public Health Emergency under the Public Health Service Act. Some recent declarations include floods in North Dakota, Hurricane Sandy in New York and New Jersey, just to mention a few.
Type of Disaster The scenarios mentioned above involve weather, however you can use modifier CR for any type of disaster, be it for explosions, mass shooting or anything that would meet the criteria for a waiver under section 1135. As soon as the president and secretary make the waiver official, you should report the disaster modifier along with any services for patients impacted by these catastrophes.
Twin Purpose for the New Modifier The new informational modifier CR could also affect payment. While CMS uses this modifier to identify claims that are conditioned by a formal Section 1135 waiver, the government uses it to streamline process claims in disaster and catastrophe situations. Tip: Append the modifier for established victims of catastrophe or disaster. This is particularly to safeguard yourself against denials for not using modifier CR in catastrophe/disaster area.
This is a short article looking at assisting with intubation. Ensure you have a good knowledge of what all devices are called so to avoid confusion if the anaesthetist or paramedic asks for a certain device. Lay out all devices required in a sterile environment so they are ready at hand when needed. Ensure you have a range of sizes for the different tools available, e.g. size 7, 8, 9 ET tubes, size 3, 4 laryngoscope blade. Place the items to the side of the operator if you are required to do chest compressions, or be at hand ready to pass over items when required. Ensure there is a Bougie or Introducer at hand in case of a difficult intubation. If these items are used be prepared to assist in feeding the ET over them so that they can be placed in the airway.
Consider whether the patient will be a difficult intubation, do they have excessive features like a large tongue or neck. Is there evidence of airway obstruction where suction or forceps may be required to remove the debris. If there is no obstruction and the health care professional is finding it difficult to intubate, consider assisting in positioning of the
Airway bag
patient and conducting airway/intubation manoeuvres (if you are not actively conducting CPR).
Consider whether there is an object such as a pillow in the vicinity where you could place it under the patients' neck to provide some better sight alignment of the airway (ensure the patient has no c-spine compromise before doing this). If able to do so, consider a jaw thrust manoeuvre or lifting of the chin to aid in opening up the airway and providing better sight. Consider the BURP (Backwards Upwards Right Pressure) manoeuvre, place some fingers on the trachea and apply some pressure in the 'BURP' order. The health care professional may direct you where to apply further pressure with what they can visualise.
You can use the Sellick manoeuvre where there is risk of the patient vomiting whilst being intubated. Locate the cricoid cartilage and apply pressure towards the oesophagus. The idea is to collapse the oesophagus so no vomit can pass through the passageway. Use judgement when applying pressure and be cautious if querying a c-spine injury.
Once the intubation process is complete have a 20ml syringe filled with air ready for the health care professional to inflate the cuff. You may need to assist in holding the stethoscope head when auscultating the patient for tube placement confirmation. Once the tube is confirmed and tied in place, attach a catheter mount and CO2 device. Confirm the presence of CO2 and begin ventilating the patient. If in a cardiac arrest scenario, you can now provide continuous ventilations. Move any of the unused equipment a safe distance away where it doesn't get in your way but is close enough to grab again if needed.
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