Question

Discussion: Reimbursement Issues for Nurse Practitioners

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.

By Day 3

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

Introduction

It is a fact that, nurses can work independently to become Nurse Practitioners. They have the autonomy to work without tie up with physicians. Due to this. the number of NPs ( Nurse Practitioners ) are increasing. However they have to lot of challenges when it comes to reimbursement. The main challenges of reimbursement to NPs are

1. Reimbursement depend on regulatory factors of both state and federal level
2. Eventhough, APRN has the right to get the payment , they have to depend on the physician for payment system
3. It is true that, insurers have their own agenda to follow Medicare Guidelines, infact, they regulate reimbursement, their own way

Fraudulent billing and their impact on NPs during practice

1. NPs are under rules and regulation
2. The factors which affects NPs are Increased number of patients and Documentation of each actvity which consumes more time and energy, without the help of enough number of staffs to complete the work.
3. NPs would be more careful about their work, if any negative outcomes, it may result in legal action. However they have professional liability insurance which protects their family and assets.
4. But, if any NP commited any mistakes ( legal proceedings), employer focus on their own reputation and capital.

Ethical and legal implications

1. When a case went against both employer and employee ( NP), the former will go against the latter.
2. Employer have the right to complaint againt employee at state board nursing council, which may affect the carreer of the employee.
3. It is a fact that employers policy does not cover employees license which helps the employer to argue that employee did not follow the protocols and procedure
4. If the board decides disciplinary action against an employee after investigation, the future of a Nurse Practitioner will be in trouble.
5. Summary
6. It is better for NPs to be aware of policies and protocols to be followed. They can clarify the doubts with the employers. For Example: Employers Insurance company ratings, NPs individual limit of liability, Level of coverage and duration in a day,
7. Collaborative agreement helps joint practice with physicians.NPs prefer colloborative agreement than helping role for physician, which helps nurses to show their calibre. But to work as independent practice, NP should be more competent.
8. It is advised that NPs shpuld be aware of business concept of care. They should be well known regarding Insurance and medicare billing regulations, CPT codes, Inpatient & Oupatient billing regularities and job responsibilities to become a clinical competitor.