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M. Mitch, M.B. B.CH., M.B.B.Ch., Ph.D.
Vice Chair, Indiana University School of Medicine
They can be used to clean up any kind of oil on any shoreline that can be reached by response personnel. The use of absorbents is generally not harmful to the shoreline itself or to the organisms that live on it, and no material is left behind following the cleanup effort. Wiping with absorbent materials requires the use of a large quantity of material and several personnel. Personnel must wear proper protective clothing to minimize direct contact with the oil as they are removing it. Oil-filled absorbents and protective clothing that are used by response personnel must be properly disposed of following cleanup, which can be costly. In addition, the intrusion of many people onto an isolated shoreline may disrupt animal behaviors such as breeding or nesting. The oil is flushed from the shoreline into plasticlined trenches, then collected with sorbent materials and disposed of properly. Since many river banks, and some lakes, have vegetation extending down into or growing in the water, plants may have to be cleaned or removed. Depending on the type of oil, low-pressure washing will usually remove most of the oil from the vegetation. In a marine ecosystem, high-pressure washing usually does more harm than good by driving the oil deeper into the beach and by killing many of the organisms on the beach. Additionally, high-pressure water streams can accelerate bank erosion and dislodge organisms, such as algae and mussels, from the rocks and sediments on which they live, or can force oil deeper into sediments, making cleanup more difficult. Pressure washing has the advantage of being relatively inexpensive and simple to apply; however, it requires many people. The cleanup of an oiled shoreline can create different types of waste materials, including liquid oil, oil mixed with sand, and tar balls. Oil can sometimes be recovered and reused, disposed of by incineration, or placed in a landfill. Reuse or recovery of oil requires that the oil be processed and separated from the other materials, such as water, that are mixed in with it. The recovered oil can then be blended with other fuels for use in power plants or boilers. Incineration uses extremely high temperatures to convert compounds, such as oil, into carbon dioxide and water. When a mobile incinerator is used at a remote spill site, the need for transporting large volumes of oiled wastes to distant disposal sites is eliminated. This can be a practical and efficient method to manage large volumes of waste generated during a cleanup. Because incineration can potentially produce air pollution, it is important that it be used in strict compliance with air pollution laws. The oil is mixed with chemicals, such as calcium oxide ("quicklime"), that stabilize the oil and make it less able to leak into groundwater or soils. Mixtures of quicklime and oil must sometimes be taken to specially designed landfills for disposal. Raking or Bulldozing When oil moves downward into the sands or between pebbles and cobbles on a shoreline, it becomes more difficult to remove. If the oil has moved downward only a short distance, tilling or raking the sand can increase evaporation of the oil by increasing its exposure to air and sunlight. If the oil has penetrated several inches into the sand, bulldozers may be brought in to remove the upper layers of sand and pebbles. This allows the oil to be exposed so it can be collected and removed from the site, washed with pressure hoses, or left to degrade naturally. Raking and bulldozing are simple methods for helping to remove oil that might otherwise escape into sediments. However, these methods can disturb both the natural shape of the shoreline and the plant and animal species that live on and in the sediments.
If all of the copied items do not apply to the second cat, you can manually delete them from the invoice. When finished adding items for the patient, click the Copy To button (located at the bottom right of the Client Invoice window). To view inactive pets belonging to the client, click the Include inactive patients check box. If any group items were used on the first patient, we recommend that you click the Re-expand smart and nested groups check box when copying items to other patient(s). When this box is selected, you are prompted to answer any age-dependent or weight-dependent questions when the services are copied. Lines on the Patient Visit List that have not been transferred or lines added to the invoice after the copy are not copied. Open the invoice you wish to void by doing one of the following: · · With the client selected on the Client Invoice window, press F2 in the Invoice number field to select the applicable closed invoice from the Invoice List. With the applicable invoice displayed on the Client Invoice window, click the Void button. Select the Check to confirm the void check box to confirm that you want to void this invoice. If desired, type the reason for the void and any applicable comments in the Comments text box. If a payment existed on the original invoice, a prompt appears to automatically reverse (void) the payment. Note: If the payment was a credit/debit card payment, the Payment dialog box opens so you can immediately void the credit card transaction in Cornerstone. See "Voiding a Credit Card Payment Transaction in Cornerstone" on page 205 for information on this process. The transaction information includes the date, the voided invoice number, the staff, and any comments. The original invoice line item is marked as Voided, along with the date of the void. Note: Clear the Hide voided items check box to view voided invoices and voided payments in client account history. You can perform a variety of actions using the buttons on the right side of the Client Account window. You can also record multiple payments (such as half the bill paid by cash, the other half by check). Before You Begin Set up your Account defaults (Controls > Defaults > Practice and Workstation > select Account in the navigation pane on the left). On the Patient Clipboard, select the client and in the Client information area, click the Account Information tab. Change given appears based on the Calculate change given setting in Account defaults. If the client is paying off the account, right-click in the Amount field and select Client balance. If the client is paying off the balance of the invoice, right-click and select Invoice balance. If you have set up a payment type prompt, the prompt appears next to the payment type. To print a list of payments you accepted during a day, print the End of Day report Daily Payment Register. Cornerstone works with a third-party payment processing provider to process credit and debit card transactions through an Internet connection. If you cannot find the answer to your question in the Help or manual, you can contact Accelerated Payment Technologies Customer Care for technical support toll-free at 1-800-338-6614. Initiating a Credit or Debit Card Payment from Cornerstone To initiate a credit or debit card payment from Cornerstone: Note: the signature icon is displayed on the Account Information tab on the Patient Clipboard* and on the Client Account window for any credit card payments that were electronically signed.
Administrative denials are made when a contractual requirement is not met, such as late or lack of notification of admissions or failure to obtain precertification, if required. Preadmission testing must be performed by an Amerigroup-preferred lab vendor or network facility outpatient department. Services and supplies not directly related to patient care (telephone charges, take-home supplies, etc. Prior authorization is required for certain laboratory services except hospital laboratory services in the event of an emergency medical condition. Updated physician prescriptions for ongoing orders for supplies and services are required annually. All prescriptions for medical equipment and supplies provided in the home must be signed or cosigned by a physician with the following exceptions: Supplies and equipment necessary for or ancillary to the administration of pharmaceuticals or monitoring their effectiveness, including glucose monitors, glucose test strips, lancets, insulin pens, needles, syringes, inhalation masks, nebulizers and spacers, may be ordered by nonphysician practitioners. Respiratory supplies and equipment necessary for or ancillary to the administration or monitoring of medications including oxygen, such as inhalation masks, nebulizers and spacers, may be ordered by nonphysician practitioners within their scope of practice without a physician signature/cosignature. If a client is a resident in a skilled nursing facility, a nonphysician practitioner. If a client is discharged to their home, any order for medical equipment and supplies must be signed or cosigned by a physician. Laboratory Services (Outpatient) Medical Equipment and Supplies 85 Service Medical Injectables Coverage Guidelines Below are examples of the most commonly prescribed injectables that require prior authorization. If your observation results in an admission, you must notify us within 24 hours or on the next business day. We also request notification of obstetric care (at first visit) and obstetric admissions exceeding 48 hours after vaginal delivery and 96 hours after Cesarean section, as these require medical necessity review. Prior authorization is required for non-evaluation and management-level testing and procedures. Prior authorization is required for all other services, such as: Trauma to the teeth. Emergency admissions require notification initially, followed by clinical information within 24 business hours. Rehabilitative: Prior authorization is not required for participating providers for: An initial evaluation. Covered services include: Children: unlimited benefit Adults: Certain benefit limits apply. Studies are allowed at Washington State Health Care Authority Centers of Excellence and member homes. The Quit for Life program is available to all Amerigroup members ages 18 and older. It addresses all tobacco types, and offers: Five coach-initiated counseling calls. Access to Web Coach, a private interactive website that helps members stay on-track between calls. The ability to re-enroll and try again if smoking cessation has not been achieved by the last call or at six-month survey. Prior authorization is not required for sports physicals, and they are eligible for reimbursement once every 12 months. You may also bill for both a well-visit and a sports physical on the same day by including modifier 25. Prior authorization is not required for men and women ages 21 and older: Sterilization. For members 18-20 years of age, sterilization is covered by Washington State Health Care Authority fee-for-service. Members can receive family planning services without prior authorization at any qualified provider. We have clinical staff available 24 hours a day, 7 days a week to accept prior authorization for emergency impatient requests.
Children younger than five years old must exhibit this behavior most days, while children over five must exhibit at least once weekly. The "with limited prosocial emotions" specifier points out additional traits like thrill seeking, fearlessness, and insensitivity to punishment. Multiple information sources are necessary to assess these criteria, as those who meet it may be less likely to report such behavior. First, symptoms are now grouped into three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. Fourth, a severity rating has been added to the criteria to reflect research showing that the degree of pervasiveness of symptoms across settings is an important indicator of severity. These behaviors cannot occur solely during the course of a psychotic or depressive episode or be due to bipolar disorder or substance abuse. Often bullies, threatens, or intimidates others Often initiates physical fights Has used a dangerous weapon that can harm others Has been physically cruel to others Has been physically cruel to animals Has stolen while confronting a victim Has forced someone into sexual activity 277 Disruptive, Impulse-Control, and Conduct Disorders Destruction of property 8. Steals items of a nontrivial value without confronting the victim Serious violations of rules 13. If the youth is 18 years of age or older, criteria are not met for antisocial personality disorder. They also are often exposed to the juvenile justice system because of their delinquent or disorderly behaviors. The outbursts often last fewer than 30 minutes and are provoked by minor actions of someone close, often a family member or friend. The aggressive episodes are generally impulsive and/or based in anger rather than premeditated. They typically occur with significant distress or psychosocial functional impairment. The recurrent outbursts are neither premeditated, nor are they to achieve an outcome. Thus, outbursts are impulsive or based in anger, and are not meant to intimidate or to seek money or power. Finally, the outbursts must cause the individual considerable distress, impair his or her occupational or interpersonal functioning, or be associated with financial or legal consequences. These could include temper tantrums, tirades, verbal arguments/fights, or assault without damage. These could be destroying an object without regard to its value or assaulting a person or an animal. The physical aggression does not damage or destroy property, nor does it physically injure people or animals. Additionally, the outbursts cannot be better explained by or attributable to another disorder. The symptoms of this disorder include: 279 Disruptive, Impulse-Control, and Conduct Disorders · · · · · · Deliberately and purposefully setting a fire more than one time. Having a fascination with, interest in, curiosity about, or attraction to fire and its uses and consequences. Feeling pleasure, relief, or gratification when setting fires or when seeing the aftermath of a fire or the damage it caused. The fires are not set for monetary gain, to cover up criminal activity, to express anger or vengeance, in response to any hallucinations or delusions, or as a result of impaired judgment (from another disorder or substance). In people incarcerated for repeated firesetting, only about 3 percent meet all the symptoms for pyromania. For more information on this disorder, please refer to the Juvenile Firesetting section of this Collection. Individuals may hoard the things they steal, give them away, or even return them to the store. The disorder is not about the objects stolen; it is about the compulsion to steal and the lack of self-control over this compulsion. Unspecified Disruptive, Impulse-Control, and Conduct Disorder Another alternative diagnosis is unspecified disruptive, impulse-control and conduct disorder. It is diagnosed when the diagnosing clinician does not specify the reason the criteria are not met for a specific diagnosis.
You need prior Plan approval for certain services the pre-service claim approval processes for inpatient hospital admissions (called precertification) and for Other services (called prior approval) are detailed in this Section. A pre-service claim is any claim, in whole or in part, that requires approval from us before you receive medical care or services. In other words, a pre-service claim for benefits may require precertification and prior approval. If you do not obtain precertification, there may be a reduction or denial of benefits. Be sure to read all of the precertification and prior approval information below and on pages 22-26. Precertification is the process by which prior to your inpatient admission we evaluate the medical necessity of your proposed stay, the procedure(s)/service(s) to be performed, the number of days required to treat your condition, and any applicable benefit criteria. Unless we are misled by the information given to us, we will not change our decision on medical necessity. In most cases, your physician or facility will take care of requesting precertification. Because you are still responsible for ensuring that your care is precertified, you should always ask your physician, hospital, inpatient residential treatment center, or skilled nursing facility whether or not they have contacted us and provided all necessary information. You are also responsible for enrolling in case management and working with your case manager if your care involves residential treatment or a skilled nursing facility. For information about precertification of an emergency inpatient hospital admission, please see page 26. We will reduce our benefits for the inpatient hospital stay by $500, even if you have obtained prior approval for the service or procedure being performed during the stay, if no one contacts us for precertification. If the stay is not medically necessary, we will not provide benefits for inpatient hospital room and board or inpatient physician care; we will only pay for covered medical services and supplies that are otherwise payable on an outpatient basis. Note: If precertification was not obtained prior to admission, inpatient benefits (such as room and board) are not available for inpatient care at a residential treatment center, or, when Medicare Part A is not the primary payor, at a skilled nursing facility. We will pay only for covered medical services and supplies that are otherwise payable on an outpatient basis. Exceptions: You do not need precertification in these cases: · You are admitted to a hospital outside the United States; with the exception of admissions for gender reassignment surgery and admissions to residential treatment centers, and skilled nursing facilities. Note: Morbid obesity surgery performed during an inpatient stay (even when Medicare Part A is your primary payor) must meet the surgical requirements described on pages 65-66 in order for benefits to be provided for the admission and surgical procedure. Precertification is also required if the service or procedure requires an inpatient hospital admission. All gender reassignment surgeries require prior approval; if inpatient admission is necessary, precertification is also required. A new prior approval must be obtained if the treatment plan is approved and your provider later modifies the plan. The organ transplant procedures listed on pages 70-71 must be performed in a facility with a Medicare-Approved Transplant Program for the type of transplant anticipated. If Medicare does not offer an approved program for a certain type of organ transplant procedure, this requirement does not apply and you may use any covered facility that performs the procedure. Not every transplant program provides transplant services for every type of transplant procedure or condition listed, or is designated or accredited for every covered transplant. Benefits are not provided for a covered transplant procedure unless the facility is specifically designated or accredited to perform that procedure. Even though we may state benefits are available for a specific type of clinical trial, you may not be eligible for inclusion in these trials or there may not be any trials available in a Blue Distinction Center for Transplants to treat your condition. If your physician has recommended you receive a transplant or that you participate in a transplant clinical trial, we encourage you to contact the Case Management Department at your Local Plan. Please note that updates to the list of drugs and supplies requiring prior approval are made periodically during the year. Changes to the prior approval list or to prior approval criteria are not considered benefit changes. Note: Until we approve them, you must pay for these drugs in full when you purchase them even if you purchase them at a Preferred retail pharmacy or through our specialty drug pharmacy and submit the expense(s) to us on a claim form.
Additional information: