Reimbursement Issues for Nurse Practitioners Discussion Assignment
NURS 6565 Week 8 Discussion: Reimbursement Issues for Nurse Practitioners
Reimbursement Issues for Nurse Practitioners Discussion Assignment – 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 Reimbursement Issues for Nurse Practitioners Discussion:
Select one of the following topics:
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
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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.
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Post at least 250 words (no introduction or conclusion)
a brief summary of the article you selected.(must be a scholarly peer reviewed article no more than 5 yrs old
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.
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-
NURS 6565 Practicum Journal Wk 8
Each week you will complete a Practicum Journal entry and Time Log that prompts you to reflect on and document your Practicum Experiences.
Practicum Journal
Continue documenting your Practicum Experiences in your Practicum Journal. Reflect on your practicum experiences and relate them to your Professional Goals and Self-Assessment of Clinical Skills that you identified in Week 1.
Follow journal entry format and choose any illness or patient…..
E.g
Reflect on a patient who presented with a disease. Describe key signs and symptoms that were consistent with this disease. If you diagnosed the patient with the disease, describe your experience in telling the patient that she had the disease, as well as the patient’s reaction to the diagnosis. Explain how the diagnosis might impact the patient’s life short-term and long-term. Include an explanation of the patient’s medical history, drug therapy and treatments, and follow-up care. If you did not have an opportunity to evaluate a patient with this background during the last four weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.
Reimbursement Rates and Medical Coding
Assignment 2:Week 6 Practicum Journal: Reimbursement Rates
Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.
In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.
Learning Objectives
Students will:
Analyze reimbursement rates for mental health treatments
To prepare for this Practicum Journal:
Research reimbursement rates for various treatment modalities.
Compare NP rates to other provider rates.
For this Practicum Journal:
Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.
Reimbursement Rate Template
Type of Service
eg. -New office visit
-Established office visit
-Inpatient hospital
-individual psychotherapy
-group psychotherapy (see examples below)
CPT code
Private insurer reimbursement rate for PMHNP
Private insurer reimbursement rate for physicians
Medicare
reimbursement rate for PMHNP
Medicare
reimbursement rate for physician
As the PMHNP becomes proficient in diagnosing and treating, it is also important to learn how to bill for your time. The CMS sets up codes to identify the type of service you are providing. You will generally complete this task at the end of the visit as you are documenting the visit with the client. Here are examples of the codes to know:
CPT Codes for Psychiatric and Psychological Procedures
HMSA recognizes the following service codes for the reporting of psychiatric and psychological services. (See Code Books for information on how to obtain the books.)
CPT Code
Footnote(s)
Description
90791
1
Psychiatric diagnostic evaluation
90792
1,3
Psychiatric diagnostic evaluation with medical services
90832
2
Psychotherapy, 30 minutes with patient and/or family member
90833
2,3
Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service
90834
4
Psychotherapy, 45 minutes with patient and/or family member
90836
3,4
Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service
90837
6
Psychotherapy, 60 minutes with patient and/or family member
90838
3,6
Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service
90839
6
Psychotherapy for crisis; first 60 minutes
90840
2
each additional 30 minutes
90846
4
Family psychotherapy (without the patient present)
90847
4
Family psychotherapy (conjoint psychotherapy) (with patient present)
90849
4
Multiple-family group psychotherapy
90853
4
Group psychotherapy (other than of a multiple-family group)
90870
1, 5
Electroconvulsive therapy (includes necessary monitoring)
96101
1
Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour.
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis.
96118
1
Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis.
Links to websites that discuss this:
https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement
http://www.mb-guide.org/medical-coding-guidelines.html
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