Week 8: Coding and Billing Issues

Week 8: Coding and Billing Issues

As you are now approaching graduation, your clinical exposure has allowed you to better understand the coding and billing process. An essential element in clinical practice will be reimbursement. All NPs must give due diligence and ensure all services provided are accurately coded and billed appropriately. Avoiding fraudulent billing is a key element to your success as an NP. As providers, we are ultimately responsible for billing that occurs with our assigned Medicare, Medicaid, and other third party reimbursement entities’ assigned numbers.

This week you will focus on understanding the differences in levels of billing and the importance of coding accurately. Additionally, billing barriers, which inhibit independent practice, and how this impacts your decision on relocating to an alternate state to have independent practice will be reviewed.

Learning Objectives

By the end of this week, students will:

Analyze reimbursement issues

Compare the impact of reimbursement issues between collaborative practice and independent practice

Analyze ethical and legal implications of reimbursement issues

Learning Resources

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)

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, 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.

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.

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.