Reimbursement Issues

In the medical field, there are many forms of caregivers that can tend to a diverse population of patients. Of these caregivers, a nurse practitioner (NP) has the ability to treat specific conditions without a doctor’s observation. However, NPs also carry with them a great amount of responsibility, especially when it comes to the business management and legal considerations that go along with patient care. NPs need to have a complete comprehension of these two aspects of as their profession grows. This paper will discuss the following: principles of fiscal management and budgeting, reimbursement issues, and several legal concepts embedded in patient care.
Fiscal Management and Budgeting There are five basic principles of fiscal management
This safeguards the business practices that the organization or healthcare practice is about the endure. These experts support the practice or organization with such items as costs, expenses, financial gains, and losses. An organization can also benefit from using external resources to help with aspects of reimbursements (Parkin, 2009),
Reimbursement Issues
Current Procedural Terminology (CPT) In 1966, the American Medical Association first founded Current Procedural Terminology (CPT) codes. In the United States, CPT codes are five-digit numbers used as an unvarying style of language used to report medical services in terms of reimbursement (American Academy of Professional Coders [AAPC], 2016). Acute care nurse practitioners (ACNP) need to be proficient in using CPT codes because those codes are directly related to an ACNP’s pay (Richmond, Thompson, & Sillivan-Marx, 2000). A crucial aspect of using CPT codes is documentation and ensuring the correct codes are used for the services provided, included the time a service is being conducted. For example, CPT code 99291 is used during the first 30-74 minutes of assistance, but can only be used once on a day-to-day basis (Magdic, 2013).
Of course, inaccurate documentation can cause reimbursement issues for the
There is no exception when it comes to NPs. They are legally and professionally responsible for their treatment towards their patients. Malpractice suits are on the rise, which is directly connected to the rise in the amount of NPs. The difference between negligence and malpractice is as follows: negligence is a failure to use care, while malpractice is an unethical skill practiced. Between the terms are closely related, negligence is often accompanied with malpractice claims (Walker, 2011). There are four elements of a negligence claim that must be considered in civil law: legal duty determined by the scope of practice, breach of legal duty as determined by the court, the cause of the breach, and the damages that occurred. Based on these elements, it is paramount that NPs practice with that patient’s rights in mind in order to avoid any negligence claims (Walker 2011).
Patient Autonomy As covered by the Patient Self-Determination Act of 1990, NPs must understand that patient autonomy includes patients having the right to make their healthcare decisions and the right to privacy in that their conditions and treatments are kept between the patient and the NP. The relationship between the patient and NP can be a fragile one, and the NP must ensure they are giving the care that the patient is requesting (Walker,