1. Prepare examples of various coding and billing issues that you have experienced in the clinical setting (Peds and women’s health).

2. Provide a brief description about the NPI numbers for nurse practitioners.

Read the following article:

https://journals.lww.co m/jwocnonline/Fulltext/ 2012/03001/Reimburse ment_of_Advanced_Pra ctice_Registered.4.aspx

Answer: 

According to the American Academy of Pediatricians. (2020), current Procedural Terminology (CPT) has specific guidelines for using time as a key factor in determining the level of evaluation and management (E/M) service. First, it is paramount to remember the key factors in determining the level of CPT code which include history, physical examination, and medical decision making for the service. The level of selecting most E/M codes would be determined by these three key factors. In the pediatric practice, pediatricians’ needs to take into consideration the additional time they spent with patients, because it might change the level of coding that is used. On the other hand, time is the key factor when the counseling, coordination of care, or both account for more than fifty percent of the face-to-face time with the patient and/or family. When this situation occurs, it is necessary to enter the total duration of counseling and/or coordination of care into the clinical notes, as well as a description of the counseling and/or coordination of care that took place.

 For example, this future practitioner has performed a detailed history and examination, with the decision making as low complexity, and sixty minutes are spent with the patient; forty minutes of which are spent counseling the patient, the visit is coded 99205 which CPT guidelines indicate has a typical time of 60 minutes rather than 99203, which CPT guidelines indicate has a typical time of 30 minutes, for a new patient. (AAP, 2020). Besides, other issue in the office and other outpatient visits is that face-to-face time is defined as the amount of time the practitioner spends in the room with the patient. It does not include any other nurse time preparing the patient or giving injections. Coding to a general level or under coding could lead to a rejected or denied claim.

The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). The numbers do not carry other information about healthcare providers. As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that might need it for billing purposes

References

American Academy of Pediatricians. (2020). Coding Tips for Pediatricians: Evaluation and

Management Coding Strategies. Retrieved from https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Coding-at-the-AAP/Pages/Coding-Tips-for-Pediatricians-Evaluation-and-Management-Coding-Strategies.aspx

American Academy of Pediatricians. (2020). 2020 Coding and Reimbursement Tip Sheet for

Transition from Pediatric to Adult Health Care. Retrieved from https://www.gottransition.org/resource/? 2020-coding-tip-sheet

CMS. 2019. National Provider Identifier Standard (NPI). Retrieved from

https://www.cms.gov/Regulations-and-Guidance/Administrative-  Simplification/NationalProvIdentStand

Peer Review for Cultural and Ethical Perspective Inquiry Draft

Post a draft of your cultural and ethical inquiry paper for peer review. You should also post your level 1 and level 2 research questions. Identify any questions or challenges you faced with the assignment, or mention something new you learned about the research question and inquiry paper process. Pose specific questions you would like your peers to address.

 PLEASE  FOLLOW THE REQUIREMENT STEP BY STEP

Requirements:

This paper should clearly and comprehensively discuss a chronic health disease. 

Week 6 Paper:  Cystic Fibrosis 

The data should reflect the United States.  My state is Maryland, My county is Howard, My city is laurel 

The paper should be organized into the following sections:

1. Introduction (Identification of the problem) with a clear presentation of the problem as well as the significance and a scholarly overview of the paper’s content. No heading is used for the Introduction per APA current edition. 
2. Background and Significance of the disease, to include: Definition, description, signs and symptoms, and current incidence and/or prevalence statistics by state with a comparison to national statistics pertaining to the disease.  Create a table of incidence and prevalence rates by your geographic county/city or state with a comparison to national statistics. Use the APA text for formatting guidelines (tables).  This is a table that you create using relevant data, it should not be a table from another source using copy/paste.
3. Surveillance and Reporting: Current surveillance methods and mandated reporting processes as related to the chronic health condition chosen should be specific.
4. Epidemiological Analysis:  Conduct a descriptive epidemiology analysis of the health condition. Be sure to include all of the 5 W’s:  What, Who, Where, When, Why.  Use details associated with all of the W’s, such as the “Who” which should include an analysis of the determinants of health.  Include costs (both financial and social) associated with the disease or problem.
5. Screening and Guidelines:  Review how the disease is diagnosed and current national standards (guidelines).  Pick one screening test (review Week 2 Discussion Board) and review its sensitivity, specificity, predictive value, and cost. 
6. Plan:  Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation.  Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility, are useful?)  Note:  Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts.  All interventions should be based on evidence – connected to a resource such as a scholarly piece of research. 
7. Summary/Conclusion: Conclude in a clear manner with a brief overview of the keys points from each section of the paper utilizing integration of resources. 
8. The paper should be formatted and organized into the following sections which focus on the chosen chronic health condition.
9. Adhere to all paper preparation guidelines (see below).

TEXTBOOK:  Curley, L. A., & Vitale, A. P. (2016). Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part II. In Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed. 

Preparing the Paper:

1. Page length: 10 pages, excluding title page and references.  
2. APA format current edition
3. Include scholarly in-text references throughout and a reference list.
4. Include at least one table that the student creates to present information. Please refer to the “Requirements” or rubric for further details.  APA formatting required.  
5. Length: Papers not adhering to the page length may be subject to either (but not both) of the following at the discretion of the course faculty: 1.  Your paper may be returned to you for editing to meet the length guidelines, or, 2. Your faculty may deduct up to five (5) points from the final grade. 

Peer Review for Cultural and Ethical Perspective Inquiry Draft

Post a draft of your cultural and ethical inquiry paper for peer review. You should also post your level 1 and level 2 research questions. Identify any questions or challenges you faced with the assignment, or mention something new you learned about the research question and inquiry paper process. Pose specific questions you would like your peers to address.