Pamela Keeme
Reimbursement Methodologies
1) Focus on Payment Methodologies and discuss the various payment systems. Demonstrate understanding of fee for service, cost based, and prospective payment systems. Just like coding systems are different, payment methodologies for inpatient hospital, outpatient hospital, and professional claims are also different. Many commercial payers follow the lead of Medicare once it has implemented a specific payment system(Aalseth, P. 2015).
Fee For Service- This is the most traditional, simple payment system. For this payment system, a service is billed using a CPT or ICD procedure code. The payer has a fee schedule with a set reimbursement amount for each service it covers. The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Most physician services are paid according to a fee schedule. Clinical laboratory services are paid based on a laboratory fee schedule, and ambulance services are paid on an ambulance fee schedule.
Cost Based or Reasonable Cost- Under this payment system, providers or facilities submit an annual cost report that details the expenses of running their businesses. There are extensive rules for completing this cost report. Examples are: data on bed utilization, salaries by cost center, expenses by cost center, indirect costs related to items such as medical education, cost-to-charge ratios, capital expenditures, and other items. In most cases the facility has been receiving periodic interim payments from the payer throughout the year, and the cost report is then used to “settle” or reconcile the costs to the payments already received. For Medicare, the cost reports are submitted to the Fiscal Intermediary (FI), which reviews and/or audits the cost report and then submits it to the CMS for reporting. PIP (periodic interim payments) are available to inpatient hospitals, skilled nursing facility services, hospice services, and critical access hospitals. These facilities are supposed to self-monitor their PIP payments to make sure they are not receiving overpayments or they can be penalized if overpayment exceeds 2% of the total in two consecutive fiscal reporting periods.
Prospective Payment System- In order to change hospital behavior to encourage more efficient management of medical care, Medicare introduced hospital inpatient prospective payment in 1983. Using a system that was developed in the 1970s by Yale University, reimbursement to hospitals was based on diagnosis-related groups (DRGs). Data already appearing on the claim form are used to assign each patient discharge into a DRG: Examples are Principal diagnosis, Complications and comorbidities (CCs), Surgical procedures, Age, Gender, and Discharge disposition (died, transferred, went home). Once a DRG has been assigned, the determination of the reimbursement amount can start. Each DRG has a relative weight assigned to it. Patients in a given DRG are assumed to have similar conditions, receive similar services, and use similar amounts of hospital resources. The prospective payment system is based on paying the average cost to treat patients in that DRG. The DRG weights are adjusted annually. The more complex the DRG, the higher the weight.
2) Explain medical necessity and how it impacts payment- To determine medical necessity, it involves comparing the procedure being billed to the diagnosis submitted. If you receive a denial notice from the payer that the procedure was “not medically necessary”, it means that your payer does not think the procedure or test was justified for the diagnosis given. Medicare carriers publish what are known as “Local Coverage Determinations” (LCDs) that contain lists of diagnosis codes that validate procedures. If your diagnosis is not on the list, your claim will be rejected. If the provider of the service knows in advance that a service is likely to be deemed not medically necessary, he or she can ask the patient to sign an Advance Beneficiary Notice (ABN) in which the patient acknowledges the possibility the claim will not be paid and agrees to be financially liable for the charge.
3) What has been the effect of payment methods on coding? Medical billing procedures have been much more effective since the advent of the CPT medical coding system. Developed by the AMA, the CPT system was designed to help facilitate and standardize medical billing practices. The coding system consists of alpha-numerical codes which are designated to describe the various services and treatments a doctor or medical facility performs on their patients. These codes are entered into a database system which is used for billing insurance companies, Medicare and Medicaid. Through the use of this billing system, medical professionals are better able to keep track of their financial records and receipt of their medical payments(findacode.com).
Aalseth, P. (2015). Medical Coding. What It Is and How It Works. Second Edition. Burlington, MA. Jones & Bartlett Learning
https://www.findacode.com/articles/the-impact-of-coding-system-on-medical-billing
Post 2
Richard Matos Week 4 – Payment MethodologiesCOLLAPSE
Fee for service is a method in which doctors and providers receive payment for services provided and the most traditional payment mechanism. Services are billed using a CPT or ICD code, The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Laboratory and ambulance services are paid on a laboratory and ambulance fee schedule. (Aalseth P.T., 2015).
Under Reasonable Cost or Cost Based providers and facilities present a detail report of the expenses of running their hospitals or clinics. The reports include bed utilization data, salaries, expenses by cost center, medical education, cost to charge ratio, capital expenses, and other items. (Aalseth P.T, 2015).
In order to control the cost of Medicare, Medicaid, and other insurance programs, Medicare introduced Hospital inpatient prospective system in 1983. Reimbursement will be based on Diagnosis-Related Group (DRG’S). Data already appearing on the claim form are used to assign each patient discharge into a DRG; Principal diagnosis, Complication, and comorbidities, surgical procedures, age, gender, and discharge disposition. Once a DRG has been assigned, the determination of the reimbursement amount can start. (Aaselth P.T., 2015).
Medical necessity involves comparing the procedure billed to the diagnosis submitted. Local Coverage Determinations are a list of diagnosis codes that validates procedures such as X-rays, EKG’s and others. If the procedure billed was not on the list the claim will be rejected.
Since the implementation of DRG’s coding made a difference in reimbursement. Coders were elevated out of the dark and into the financial limelight. Medical records departments were turned into health information management departments. The potential dollars to be made was an incentive to coders to use the right codes. (Aaselth P.T., 2015)
Reference
Aalseth, P.T. (2015). Medical Coding, what is it and how it works, (2nd ed.) Sudbury, MA: Jones & Bartlett Learning
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Discussion Post Response 19064525
/in Uncategorized /by developerQuestions asked:
Discuss some common causes for coding errors and the preventative measures you can use to avoid them.
2) What are some other measures you can add to the list that might not be in the course materials?
3) What is the Fraud and Abuse Control Program? What is the HHS OIG and what is it’s major concern?
Halle Pietras Week 3 :
OIG stands for the office of inspector general, they are an oversite agency that works for the United States department of Health and Human Services (HHS.) There goal is to promote and protect our healthcare programs. That also means they look out for things like fraud and abuse when it comes everything, even coding and billing.
When it comes to coding there is a lot to remember, but there’s also a lot left up to assumptions which is where people can get into trouble. There’s also a lot of “gray area’s” according to our book, which leaves things open to different interpretations. Those are hard things to combat but some suggestions and or rules help to eliminate them the best they can. One mandate to remember is that coding MUST be supported by a health record. Another one to prevent fraud would be to use outside auditors to review the claims and make sure things check out. Other basic things would be to monitor and double check the claims, to make sure everything is the most correct you can make it. Make sure you understand what you’re doing and if not ask someone who could advise you.
Reference
Aalseth, P. (2015). Medical Coding: What Is it and How It Works (2nd ed.). Burlington, MA: Jones & Bartlett Learning
Post 2
Richard Matos Week 3 – Discussion forumCOLLAPSE
Richard Matos
Professor J. Pryor
CPT Coding for Health Services Administration
Coders generally make two types of errors when making coding decisions; Performance errors and Systematic errors. Performance errors include misreading words, missing important details to the code assignment, failing to pull together details from various parts of the record and transposing digits in code numbers. Systematic errors include lack of sufficient medical knowledge to understand the documentation, lack of knowledge of or misapplication of coding rules.
To avoid errors coding departments should verify the patient’s insurance benefits and personal information, double check diagnosis and procedures codes, write clearly and implement an EHR billing system. Conducting charts audits are also a good way to avoid submitting claims twice. Proper training, care and attention to details is the best policy to avoid coding errors. also, managers should implement policies and programs to help staff better understand the importance of avoiding errors.
The U.S. Department of Health and Human Services established a Fraud and Abuse Control Program, effective January 1, 1997, to fight health care fraud, waste, and abuse. The Office of Inspector General (OIG) carries nationwide audits, investigations, and inspections in order to protect the integrity of the HHS. The OIG also has the authority to investigate hospitals, pharmaceutical manufacturers, third-party billing companies, ambulance companies, physicians practices, nursing facilities, home health agencies, clinical laboratories, hospices and companies that supply durable medical equipment, prosthetics, and orthotics. The OIG also works with the FBI and other federal agencies in the investigation of fraud and abuse.
WC-262
Reference
https://www.m-scribe.com/blog/bid/291707/5-Tips-to-Help-Your-Practice-Avoid-Medical-Billing-Errors
https://www.cms.gov/newsroom/fact-sheets/health-care-fraud-and-abuse-control-program-protects-consumers-and-taxpayers-combating-health-care-0
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Discussion Post Response 19075615
/in Uncategorized /by developerPamela Keeme
Reimbursement Methodologies
1) Focus on Payment Methodologies and discuss the various payment systems. Demonstrate understanding of fee for service, cost based, and prospective payment systems. Just like coding systems are different, payment methodologies for inpatient hospital, outpatient hospital, and professional claims are also different. Many commercial payers follow the lead of Medicare once it has implemented a specific payment system(Aalseth, P. 2015).
Fee For Service- This is the most traditional, simple payment system. For this payment system, a service is billed using a CPT or ICD procedure code. The payer has a fee schedule with a set reimbursement amount for each service it covers. The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Most physician services are paid according to a fee schedule. Clinical laboratory services are paid based on a laboratory fee schedule, and ambulance services are paid on an ambulance fee schedule.
Cost Based or Reasonable Cost- Under this payment system, providers or facilities submit an annual cost report that details the expenses of running their businesses. There are extensive rules for completing this cost report. Examples are: data on bed utilization, salaries by cost center, expenses by cost center, indirect costs related to items such as medical education, cost-to-charge ratios, capital expenditures, and other items. In most cases the facility has been receiving periodic interim payments from the payer throughout the year, and the cost report is then used to “settle” or reconcile the costs to the payments already received. For Medicare, the cost reports are submitted to the Fiscal Intermediary (FI), which reviews and/or audits the cost report and then submits it to the CMS for reporting. PIP (periodic interim payments) are available to inpatient hospitals, skilled nursing facility services, hospice services, and critical access hospitals. These facilities are supposed to self-monitor their PIP payments to make sure they are not receiving overpayments or they can be penalized if overpayment exceeds 2% of the total in two consecutive fiscal reporting periods.
Prospective Payment System- In order to change hospital behavior to encourage more efficient management of medical care, Medicare introduced hospital inpatient prospective payment in 1983. Using a system that was developed in the 1970s by Yale University, reimbursement to hospitals was based on diagnosis-related groups (DRGs). Data already appearing on the claim form are used to assign each patient discharge into a DRG: Examples are Principal diagnosis, Complications and comorbidities (CCs), Surgical procedures, Age, Gender, and Discharge disposition (died, transferred, went home). Once a DRG has been assigned, the determination of the reimbursement amount can start. Each DRG has a relative weight assigned to it. Patients in a given DRG are assumed to have similar conditions, receive similar services, and use similar amounts of hospital resources. The prospective payment system is based on paying the average cost to treat patients in that DRG. The DRG weights are adjusted annually. The more complex the DRG, the higher the weight.
2) Explain medical necessity and how it impacts payment- To determine medical necessity, it involves comparing the procedure being billed to the diagnosis submitted. If you receive a denial notice from the payer that the procedure was “not medically necessary”, it means that your payer does not think the procedure or test was justified for the diagnosis given. Medicare carriers publish what are known as “Local Coverage Determinations” (LCDs) that contain lists of diagnosis codes that validate procedures. If your diagnosis is not on the list, your claim will be rejected. If the provider of the service knows in advance that a service is likely to be deemed not medically necessary, he or she can ask the patient to sign an Advance Beneficiary Notice (ABN) in which the patient acknowledges the possibility the claim will not be paid and agrees to be financially liable for the charge.
3) What has been the effect of payment methods on coding? Medical billing procedures have been much more effective since the advent of the CPT medical coding system. Developed by the AMA, the CPT system was designed to help facilitate and standardize medical billing practices. The coding system consists of alpha-numerical codes which are designated to describe the various services and treatments a doctor or medical facility performs on their patients. These codes are entered into a database system which is used for billing insurance companies, Medicare and Medicaid. Through the use of this billing system, medical professionals are better able to keep track of their financial records and receipt of their medical payments(findacode.com).
Aalseth, P. (2015). Medical Coding. What It Is and How It Works. Second Edition. Burlington, MA. Jones & Bartlett Learning
https://www.findacode.com/articles/the-impact-of-coding-system-on-medical-billing
Post 2
Richard Matos Week 4 – Payment MethodologiesCOLLAPSE
Fee for service is a method in which doctors and providers receive payment for services provided and the most traditional payment mechanism. Services are billed using a CPT or ICD code, The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Laboratory and ambulance services are paid on a laboratory and ambulance fee schedule. (Aalseth P.T., 2015).
Under Reasonable Cost or Cost Based providers and facilities present a detail report of the expenses of running their hospitals or clinics. The reports include bed utilization data, salaries, expenses by cost center, medical education, cost to charge ratio, capital expenses, and other items. (Aalseth P.T, 2015).
In order to control the cost of Medicare, Medicaid, and other insurance programs, Medicare introduced Hospital inpatient prospective system in 1983. Reimbursement will be based on Diagnosis-Related Group (DRG’S). Data already appearing on the claim form are used to assign each patient discharge into a DRG; Principal diagnosis, Complication, and comorbidities, surgical procedures, age, gender, and discharge disposition. Once a DRG has been assigned, the determination of the reimbursement amount can start. (Aaselth P.T., 2015).
Medical necessity involves comparing the procedure billed to the diagnosis submitted. Local Coverage Determinations are a list of diagnosis codes that validates procedures such as X-rays, EKG’s and others. If the procedure billed was not on the list the claim will be rejected.
Since the implementation of DRG’s coding made a difference in reimbursement. Coders were elevated out of the dark and into the financial limelight. Medical records departments were turned into health information management departments. The potential dollars to be made was an incentive to coders to use the right codes. (Aaselth P.T., 2015)
Reference
Aalseth, P.T. (2015). Medical Coding, what is it and how it works, (2nd ed.) Sudbury, MA: Jones & Bartlett Learning
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Discussion Post Week 1
/in Uncategorized /by developerPlease answer to this discussion post. No less than 150 words. Reference and APA style needed. Please no plagiarism. Similarity is <20%. Thanks
The most interesting thing about this chapter is that it helps people and scholars to develop skills to influence strategy in nowadays changing healthcare environment. The topic also contributes an extensive range of themes in strategies and politics, offering more complete contextual that can be in other policies textbook in the market (Mason, Leavitt, & Chaffee, 2013). The topics also entail up-to-date updates concerning conflict organization, health economics, politicization, use of media as well as working with societies for change. Reviewed copy take account of new supplement with coverage of advanced reasonably priced care act. According to this perceptions and strategies, every individual will be equipped and ready to play a leadership role under four spheres where nurses are governmentally efficient, the workstation, government, specialized organization as well as the community (American Nurses Association, 2010). The topic has helped me to know more of nursing and healthcare policies and politics.
In thus, have understood that the concept of nursing policies influences can be defined as a nursing ability to have active, effective on decision making as well as affairs connected to health care by use of power, support, and strategy capability, and establishing or strengthening images. The nursing policy and politics within a healthcare connect to my clinical practices because as a nurse, I should view myself as a professional with the ability and being responsible for influencing recent and forthcoming health care conveyance system. But to attain this, there must be the presence of policies that define and assimilate suitable standards for healthcare delivery as well as addressing essential conditions for that care to happen.
References
American Nurses Association. (2010). Nursing’s social policy statement: The essence of the profession. Nursesbooks. org.
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2013). Policy and Politics in Nursing and Healthcare-Revised Reprint. Elsevier Health Sciences.
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Discussion Posts 19283569
/in Uncategorized /by developer***DO NOT PUT IN ESSAY FORM, BUT YET AS ANSWERING TO EACH QUESTION BY THE NUMBER ASSIGNED TO IT.
DISCUSION #1:
In your initial post, consider the Four Prototypic Dimensions of Parenting and address the following:
Be sure to support your responses and give examples.
DISCUSSION #2:
This module introduces the topic of puberty and explores how children develop physically, psychosocially, and cognitively during this time. Often, parents/caregivers are not comfortable talking with children about the changes they experience during puberty and, consequently, leave children to figure things out on their own.
As a parent/guardian, what do you think would be important to tell a child about puberty? Describe at least one thing you would explain from each of the following categories:
DISCUSSION #3:
Explain the positive and negative aspects of the living arrangements for the elderly listed below. Be sure to thoroughly evaluate each option.
DISCUSSION #4:
While life expectancies continue to increase, differences exist between men and women. As a general rule, women outlive men, yet there are a few countries where men survive longer than women.
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Discussion Posts 19458025
/in Uncategorized /by developerWrite a short discussion on the following question. Make sure to put reference on each discussion and at the end of the discussion
1. Choose one model for EBP implementation. Describe its components and why you believe this model is most appropriate for assisting in translational activities. Contrast this model with another.
2. Discuss the role of the DNP-prepared nurse in sustaining an EBP culture. What are two effective methods the DNP can use in sustaining an EBP culture?
3. Describe and discuss the differences between research, research utilization, and evidence-based practice. Provide examples.
4. Describe how you will assist others to generate their own evidence-based practice questions. Discuss what your professional obligation as a DNP-prepared nurse is related to evidence-based practice, patients, and other nurses?
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Discussion Posts Must Be Minimum 250 Words References Must Be Cited In Apa Format And Must Include Minimum Of 2 Scholarly Resources Published Within The Past 5 7 Years
/in Uncategorized /by developerReflect on Florida’s current health education programs such as Zika Free Florida, Tobacco Free Florida and consider what part the media plays in such disease prevention programs. Identify a specific public health issue that you believe needs to be highlighted in health policy and based on your textbook readings discuss how social media can be used as a health promotion tool to improve public awareness on the selected topic.
2 scholarly resources published within the past 5-7 years
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Discussion Posts Must Be Minimum 250 Words Two References Must Be Cited In Apa Format And Must Include Minimum Of 2 Scholarly Resources Published Within The Past 5 7 Years See Attachment Similarity No More Than 15
/in Uncategorized /by developerReview both resources provided below in addition to the assigned readings for this week and reflect on 2 key differences between the UK and US Health systems. What are key opportunities related to advocacy and politics interventions that can be taken by advanced practice nurses to improve our current health system?
See attachment similarity no more than 15%
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Discussion Postthree Nursing Concepts Related To Using The Nursing Process For Safe Medication Administration
/in Uncategorized /by developerNeed a small discussion post in regards to three nursing concepts related to using the nursing process for safe medication administration. It does required citation nor references.
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Discussion Presentations Of Adhd 19481845
/in Uncategorized /by developerCase #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder
Patient evaluation on intake•
31-year-old man with a chief complaint of anxiety of “different types” •Patient states that he “has been successful in graduate school, has financial worries, but states that he worries and is tense most of the time”
Psychiatric history
•Has been anxious for many years, mostly since college and now graduate school •Working part-time and going to school part-time and feels “torn in many directions” •Generally is tense, restless, irritable, and worries about things even outside school and work–When legitimate stressors diminish, the anxiety lowers, but is still present and discouraging •This causes him to be argumentative and temperamental most of the time •He says he is active and likes to stay busy all of the time, but he wonders if “he is doing too much, as he has no time for all of the things” he wants to do
Social and personal history
•Graduated high school, college, and is enrolled in a graduate-level training program for family counseling •Gainfully employed now in a clinical setting •Married and without children •Does not use drugs or alcohol.
Write a response to the following:
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Discussion Presentations Of Adhd
/in Uncategorized /by developerTO REPLY WITH A COMMENT TO EACH POST WITH TWO REFERENCE PER POST APA WITH CITATION ABOVE 2013. THE SECOND POST WILL BE GIVING TOMORROW.
Post 1
Questions
Feedback
The most important people in the client’s life that could provide valuable feedback are her mother, grandmother, and teacher because they have the most contact with the client. The grandmother is important to interview as she may have different experiences with the client while in her care. The grandmother can also be asked about the mother’s behaviors and temperament during her childhood and adolescent years, especially considering the mother is exhibiting obvious symptoms of ADHD in her adult life. Studies have shown a mean heritability rate of 75% in family studies of behavioral disorders (Wilens & Spencer, 2010). The client’s teacher can provide a overview on any specific triggers preceding her tantrums and outbursts in class, and relationships with peers. The mother should be asked about the severity of the client’s behavior and tantrums at home, relationship with sister, and level of disobedience as these assessments may indicate progression into more severe behavioral disorders suggesting prompt attention (Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, 2015).
Physical Exams and Diagnostic Tests
When diagnosing ADHD and other DBDs, a thorough physical evaluations is needed to rule out medical causes. A structural MRI could document diffuse abnormalities in children with ADHD. A study found, individuals with ADHD may have smaller total cerebrum, cerebellum, and four cerebral lobes that do not change over time; in adults, imaging studies have shown smaller anterior cingulate cortex, thought to be the region that regulates ability to focus on tasks and choose between options, and smaller dorsolateral prefrontal cortex, which controls memory and ability to process new information (Wilens & Spencer, 2010). EEG should also be considered as one study found EEG’s show more Beta activity than Theta/Alpha activity in children medication responders compared to non-medication responders, strongly suggesting a biological correlation to the behaviors in ADHD (Hamed et al., 2015). Blood chemistry, thyroid levels, and ferritin levels have also been linked to the diagnosis of ADHD.
Differential Diagnoses
Pharmacological Agents
Dexedrine Spansule 5mg daily is sustained-release amphetamine used to treat adults and children age 6 years and older with ADHD. The drug has up to an 8-hour duration of clinical action, making its use preferable over IR formulations (Stahl, 2014b). Most stimulants are highly and equally efficacious hence the label as first-line treatment for ADHD. The side effect profile consists of cardiovascular, CNS, and hormonal effects requiring pre-assessment and monitoring throughout therapy. Also, the once a day dosing is beneficial to children because it eliminates the interruption of the school day to take noon dose, maintains confidentiality, and increases likelihood of compliance (Shier, Reichenbacher, Ghuman, H., & Ghuman, J., 2013). Compared to Atomoxetine, a selective norepinephrine reuptake inhibitor used to treat ADHD in adults and children over the age of 6, amphetamines have a more robust response (Shier et al., 2013). Atomoxetine carries the FDA warning for the potential to increase suicidal ideation children and adolescents and is metabolized through the CYP2D6 pathway in which a small percentage of the Caucasian population are poor metabolizers, therefore dose adjustments may be required (Brown et al., 2018).
Lessons Learned
Recommendations for treatment usually accompany the diagnosis of ADHD and have since been a source of controversy. Although stimulant use to treat ADHD shows effectiveness in 65-75% of children after their first trial of use, the potentially dangerous side effects contribute to the indecisiveness of parents and children which affects treatment and compliance (Hamed et al., 2015). Approaching the diagnosis and suggested treatment should be done tactfully, as many parents have negative information and perceptions of the ADHD diagnosis. As the practitioner, it is imperative that the challenges associated with assessing and treated ADHD are known. The concerted effort to successfully treat children with ADHD involves family, caregivers, educators, and healthcare professionals alike.
REFERENCES
Brown, K., Samuel, S., & Patel, D. (2018). Pharmacological management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners. Translational Pediatrics, 7(1): 36-47. doi: 10.21037/tp.2017.08.02.
Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders (2015). Mental disorders and disabilities among low-income children. Washington, DC: National Academies Press (US).
Hamed, A., Kauer, A., & Stevens, H. (2015). Why the diagnosis of attention deficit hyperactivity disorder matters. Frontiers in Psychiatry, 6: 168. doi: 10.3389/fpsyt.2015.00168.
Shier, A., Reichenbacher, T., Ghuman, H., & Ghuman, J. (2013). Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: Clinical strategies. Journal of Central Nervous System Disease, 5: 1-17. doi: 10.4137/JCNSD.S6691.
Stahl, S. (2014b). The prescriber’s guide (5th ed.). St. Louis, MO: Cambridge University Press.
Wilens, T. & Spencer, T. (2010). Understanding attention deficit/hyperactivity disorder from childhood to adulthood. Postgraduate Medicine, 122(5): 97-109. doi: 10.3810/pgm.2010.09.2206.
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