W8 Discussion: Reimbursement Issues for Nurse Practitioners

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, 

1. you will search the health care literature and 2. 

2. summarize a peer-reviewed journal article published within the last five years.

To prepare:

·  3,  Select one of the following topics that u like to discuss

o  

o Applying for Medicare and Medicaid Provider Numbers

o Application process for National Provider Identifier Number

o Incident to billing

o Coding-Evaluation & Management

o Fraudulent billing

o Billing Self-Pay patients

o Managed Care Organizations

· 4. Conduct a search and select a peer-reviewed journal article published within the last five years related to the topic you selected.

Note: For this Discussion, all students are to avoid all written work, which reviews or outlines coding and billing at previous or current worksites as well as previous or current practicum sites.

5. Post a brief summary of the article you selected.

6.  Include the key reimbursement issue addressed and how they would impact the NP in a collaborative practice versus and independent practice. 

7. Discuss an ethical or legal implication(s) associated with your article.

      NOTE:

WRITE 1 PAGE

SAME AS BEFORE

DUE 1.09.2018

NO PLAGIARIS,

Use References provided

 

Required Readings

Buppert, C. (2018). Nurse practitioner’s business  practice and legal guide (6th ed.). Sudbury, MA: Bartlett & Jones  Learning.
Chapter 9, “Reimbursement for Nurse Practitioner Services” (pp. 311-325)

Optional Resources

 

Buppert, C. (2018). Nurse practitioner’s business  practice and legal guide (6th ed.). Sudbury, MA: Bartlett & Jones  Learning.

• Chapter 9, “Reimbursement for Nurse Practitioner Services” (pp. 311-325)

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-

  

Measuring Quality Guidelines and Grading Rubric

In an 8 to 10-page paper, APA format and 5 references, describe three rate based measurements of quality.

Select three rate based measurements of quality that you will use as the primary basis for this paper.

These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care.  For the purposes of this assignment, an analysis of staffing levels is not permitted.  You can find useful information on quality indicators that are of interest to you on these websites and resources.  You may choose only one of the three measures to be some form of patient satisfaction measure. 

Deconstruct each measure to include descriptions of the each of the following as numbered below: 

1) The definition of the measure 

2) The numerical description of how the measurement is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.)  

3) Explain how the data for this measure are collected 

4) Describe how the measurement is compared externally to other like settings; differentiate between the actual rate and a percentile ranking.  

5) Explain whether the measure is risk adjusted or not.  If so, explain briefly how this is accomplished.  

6) Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace. 

Describe the importance of each measure to a chosen clinical organization and setting. 

Using these websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings. Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the instructor for guidance. You do not need actual data from a given organization to complete this assignment. 

Relate each measure to patient safety, to the cost of poor quality, and to the overall cost of healthcare.

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Chapter 5: “Data Collection”

Chapter 6: “Statistical Tools for QI”

Park, J., Konetzka, R. T., & Werner, R. M. (2011). Performing well on nursing home report cards: Does it pay off? Health Services Research, 46(2), 531–554. doi:10.1111/j.1475-6773.2010.01197.x

1. The study in this article evaluates whether or not nursing homes benefit from improvements in quality measures. Four financial outcomes are measured before and after the improvements are enacted. The study shows that the nursing homes that improved quality measures benefited financially.

Suchy, K. (2010). A lack of standardization: The basis for the ethical issues surrounding quality and performance reports. Journal of Healthcare Management, 55(4), 241–251.

Because performance reports are easily found online, this article supports creating ethical guidelines for the performance reports of the health care industry. It compares nearly ten different organizations that provide performance reporting, and then it proposes an ethical framework and principles for public quality reporting.

Wachter, R. M., & Pronovost, P. J. (2009). Balancing “no blame” with accountability in patient safety. New England Journal of Medicine, 361(14), 1401–1406.

This article addresses the issue of individual accountability in health care organizations. It suggests moving from a culture within health care that does not place blame on individuals to a culture where individuals become more accountable.

Centers for Medicare & Medicaid Services. (n.d.). Quality initiatives: Overview. Retrieved from http://www.cms.gov/QualityInitiativesGenInfo/

Created by the U.S. Department of Health & Human Services, this website overviews quality initiatives that affect the health care industry. It also provides information and downloadable PDFs on the Post-Acute Care Reform Plan and Development of Quality Indicators for Impatient Rehabilitation Facilities (IRF).

Required Media

Video: Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: External quality improvement. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

The presenters in this video discuss various external organizations involved in quality, and examine the enforcement of standards by governmental agencies versus voluntary organizations. This program also addresses the publication of quality information and why organizations should do their own reporting in addition to mandated reporting. Licensing, credentialing, and certification are discussed as they relate to the social compact that health care providers have for quality and safety.

 In this assignment, you will be exploring actual and potential health problems in the childhood years using a functional health assessment and Erickson’s Stages of Child Development. 

Cite and reference all sources used in your answers, Minimum of 3 references.  Include in your assessment a thorough discussion of Erickson’s Stages of Child Development as it pertains to the development age of the child.

  NO PLAGIARISM

 Topic 3 DQ 1

From the cultural groups you reviewed for the High-Risk Nutritional Practices assignment, briefly explain an unusual high-risk practice and how it impacts your role as a medical professional with reference.

 Topic 3 DQ 2

What factors influencing nutritional practices in the United States could be changed to improve health?with reference.

 

High-Risk Nutritional Practices Paper

Examine the high-risk nutritional behaviors associated with different cultures. Identify the historical perspectives, belief systems, and other factors associated with these high-risk nutritional behaviors for each culture. Write a 1,500-3,000 word paper on your findings in which you accomplish the following:

1. Summarize the high risk-nutritional behaviors practiced among two or three different cultures.
2. Discuss the historical perspectives and belief systems of these cultures that influence the high-risk nutritional behaviors.
3. Explore additional influencing factors on high-risk behaviors for each culture. These may include, but are not limited to (a) education, (b) family roles, (c) spiritual beliefs, (d) health care practices, and (e) drug and alcohol use.

This paper requires minimum of six outside resources in addition to the textbook.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 Topic 4 DQ 1

Describe the spectrum of death and dying rituals and practices across cultures. Why are death and dying rituals so significant?

 Topic 4 DQ 2

What death and dying practices are contrary to your personal beliefs or chosen religious values? How will you support a patient’s death and dying rituals and practices, and still honor your own?

 

Allied health professionals are confronted with different death and dying practices. An effective allied health professional recognizes the importance of understanding different cultural practices, and learns how to evaluate the death, dying, and spiritual beliefs and practices across the cultures.

Read the two specified case histories and choose one for this assignment.

Chapter 4, “Stories of Abby: An Ojibwa Journey” and Chapter 14, “Stories of Shanti: Culture and Karma,” by Gelfland, Raspa, and Sherylyn, from End-of-Life Stories: Crossing Disciplinary Boundaries (2005), from the the GCU Library.

Identify your role as a health care professional in supporting Abby or Shanti’s dying rituals, and in creating strategies for displaying respect while still providing quality care. Integrate your strategies as you develop a care plan describing how you would approach the situation and care for the patient. Review the “Care Plan” template prior to beginning.

Include the following in your care plan:

1. Communication: family and patient
2. Treatment options that align with the specific culture
3. Education: family and patient
4. Family roles in the process
5. Spiritual beliefs
6. Barriers
7. Cultural responses
8. Any additional components that you feel would need to be addressed (from your perspective as a health care professional)

  

Care Plan

Patient’s Name: ____________________________________________________ Date: ________________________________________

Patient’s Diagnosis: ___________________________________________________________________________________________

  

Problems/Needs

(Include   date.)

Goals

Interventions/Actions

Discipline/Person Responsible

Outcome/Comments

(Initial and date.)

Topic 5 DQ 1

If you were caring for a child who could be cured if given blood transfusions, but whose parents refused permission to give the transfusions due to religious beliefs, what would you do?

 Topic 5 DQ 2

Some parents are refraining from giving certain immunizations to their children. How will this affect diseases in the United States in the future? How as medical professionals can we embrace these nontraditional practices?

 

Benchmark – Nontraditional Health Care Practices

Research different popular nontraditional health care practices. Write a 1,000-1,200 word paper exploring nontraditional health care practices and include the following:

1. Describe nontraditional health care practices in different cultures. Compare at least three cultures.
2. Explain how these practices affect wellness and prevention in different cultures.
3. Identify the nontraditional health care options in your areas, and identify the number of people choosing to use them over traditional medical practices. Propose reasons why the number of people using nontraditional health care options is rising.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.