Deck 12: Reimbursement for Nurse Practitioner Services

Question 1

Which aspect of the nurse practitioner's (NP's) reimbursement eligibility requirements is typically fulfilled by the practice manager?

A) Applying for a national provider number
B) Completing a third-party credentialing process
C) Requesting an employer provider number
D) Filling out an attestation form

Answer 1

Completing a third-party credentialing process

Question 2

For the nurse practitioner (NP), reduced practice authority requires which action on the part of a fellow provider?

A) Collaboration agreement
B) Supervision
C) Delegation
D) Team management

Answer 2

Collaboration agreement

Question 3

Discuss the nature and purpose of medical coding using International Classification of Diseases (ICD) codes and Current Procedural Terminology (CPT) codes.

Answer 3

Medical coding is best defined as the translation of the original medical record documentation regarding patient diagnoses and procedures into a series of code numbers that describe the information in a standard manner. Coded medical information is used for patient care, research, reimbursement, and evaluation of services. International Classification of Diseases (ICD) codes, developed by the World Health Organization, are used to identify the patient's diagnoses or reasons for seeking care. These codes cover specific illnesses or diseases as well as signs and symptoms resulting in the patient encounter. ICD codes are also useful for classifying morbidity and mortality data from inpatient and outpatient records and most National Center for Health Statistics (NCHS) surveys. Another component of medical billing is the Current Procedural Terminology (CPT), which describes the services and/or procedures for which reimbursement is sought. CPT codes are used for specific types of patient encounters, including procedures and diagnostic studies.

Question 4

Incorporate the use of Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes to explain medical necessity.

Question 5

A patient is transported to the emergency department by ambulance for treatment of respiratory distress related to asthma. The nurse practitioner (NP) orders administration of nebulized albuterol. The Healthcare Common Procedure Coding System (HCPCS) Level II code set must be used for identification of which aspect of the patient's care?

A) Ambulance transport
B) History of asthma
C) Diagnosis of respiratory distress
D) Albuterol administration

Question 6

Discuss the most important document in the reimbursement process.

Question 7

The resourced-based relative value scale (RBRVS) is directly relevant to which aspect of the nurse practitioner's (NP) practice?

A) Coordination of care
B) Credentialing
C) Medical record documentation
D) Reimbursement

Question 8

Which component of the patient history must be present in order to classify the patient interaction as Level 2/problem focused?

A) Detailed history of present illness (HPI)
B) Pertinent past family and social history (PFSH)
C) Brief history of present illness (HPI)
D) Complete past family and social history (PFSH)

Question 9

Summarize medical decision making as a key component of reimbursement for services provided by the nurse practitioner (NP).

Question 10

Discuss the use of modifiers in the context of medical coding for reimbursement.

Question 11

Explain what does every nurse practitioner have to do before being able to bill for services?

Question 12

What documentation does the CMS expect for the nurse practitioner to receive payment for services?

Question 13

What must be included in the history as a starting point to receive reimbursement?

Question 14

A client with a history of osteoporosis and arthritis is experiencing symptoms of an acute upper respiratory infection. Explain this client's level of complexity.

Question 15

What criteria must be met before "incident to" billing can occur?