Question

Understanding the complex process of accurate coding and billing is essential to a sustainable practice. As NPs, 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.

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

Answer 1

Incident to billing

Payment is completed lone on a task basis, which means that imbursement will be the Medicare allowable quantity as imbursement in full and the APRN may not bill or gather from the recipient any quantity other than unmet copayments, deductibles, or coinsurance. Facilities are remunerated at 85.75% of the Medicare Doctor Fee agenda sum. When facilities equipped to hospital inpatients and outpatients are owed unswervingly, imbursement is unbundled and completed to the APRN.

Advanced Practice Nurses necessity register in the Medicare sequencer to be qualified to obtain Medicare imbursement for enclosed services providing to Medicare recipients. Form CMS is used for doctors and non-physician doctors to pledge the Medicare registration procedure. If the APRN is portion of a surgery or group repetition, Form CMS is used to pledge the registration procedure. There is an Internet founded Provider Registration, Chain and Ownership Scheme (PECOS) that can be used. For numerous APRNs this registration procedure is introduced by their company.

The APRN must comprehend and encounter the state licensing necessities in the state where his/her distribution of amenities will take residence, must encounter the Medicare supplies to bill Medicare, and partake a NPI. Repayment by secluded insurance businesses is discrete from the Medicare procedure and might necessitate a credentialing course.

Provider facilities are compensated unconnectedly from other amenities providing in hospitals. Medicare expenditures for provider amenities are compensated through Medicare Part B. Provider amenities are distinct by Federal guidelines as analysis, rehabilitation, surgery, discussion, care plan mistake; and home, headquarters and institutional appointments. Custodies for inpatient facilities are done by means of the Current Procedural Terminology (CPT) code scheme. The Assessment and Management (E&M) facility is the greatest common provision delivered by an APRN in the hospital. The E&M facility comprises history taking, inspection, medical result creation psychotherapy, and organization of upkeep. CPT technical codes can be owed by any capable provider.