Reimbursement Issues for Nurse Practitioners

Reimbursement Issues for Nurse Practitioners

Understanding the complex process of accurate coding and billing is essential to a sustainable practice. As Nurse practitioner, we are ultimately responsible for ensuring all coding and billing is accurate for each patient seen.

For this Discussion, you will search the health care literature and summarize a peer-reviewed journal article published within the last five years.

To prepare:

Select one of the following topics:

Applying for Medicare and Medicaid Provider Numbers

Application process for National Provider Identifier Number

Incident to billing

Coding-Evaluation & Management

Fraudulent billing

Billing Self-Pay patients

Managed Care Organizations

Conduct a search and select a peer-reviewed journal article published within the last five years related to the topic you selected in  Reference as a nurse practitioner.

Post 1 to 2 page summary of the article you selected. (1) Include the key reimbursement issue addressed and (2)  how they would impact the Nurse Practitioner in a collaborative practice versus and independent practice.  (3) Discuss an ethical or legal implication(s) associated with your article.

References

Buppert, C. (2015). Reimbursement for Nurse Practitioner Services. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.). (303-319). Burlington, MA: Jones & Bartlett.

Schiff, M. (2012). The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care. Retrieved from http://www.aacn.nche.edu/government-affairs/NGA-Nurse-Practitioner-Paper.pdf

MODEL ANSWER

Coding-Evaluation & Management

The article chosen discusses determining the appropriate level of evaluation and management and choosing the correct billing PLACE ORDER FOR A COMPLETE AND CUSTOMIZED ANSWER, Harry Goldsmith (2013), looks are three guidelines to consider prior to choosing billing codes including: the number of possible diagnoses and management options, the complexity of PLACE ORDER FOR A COMPLETE AND CUSTOMIZED ANSWER records, diagnostics tests and the other information that needs to be reviewed or analyzed, and the risk of significant complications such as morbidity and PLACE ORDER FOR A COMPLETE AND CUSTOMIZED ANSWER with possible management options. Goldsmith (2013) also suggests obtaining a subscription for Codingline. Codlingline is a monthly subscription that you can receive via PLACE ORDER FOR A COMPLETE AND CUSTOMIZED ANSWER or mail that provides information regarding what should be included in medical decision making and risk factors to determine proper PLACE ORDER FOR A COMPLETE AND CUSTOMIZED ANSWER. Goldsmith (2013) pointed out that there is no “one size fits all,” and the level of risk should be determined by the patient’s situation……………..PLACE ORDER FOR A COMPLETE AND CUSTOMIZED ANSWER……………..

References

Buppert, C. (2015). Reimbursement for nurse practitioner services. In Nurse Practtioner’s Business Practice and Legal Guide (5th ed.). (303-319. Burlington, MA: Jones & Bartlett.

Goldsmith, H. (2013). E/M coding: Medical decision-making in the making. Podiatry Management, 1. Retrieved from Walden Library Database.

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