Business And Legal Considerations For The Agacnp. Reimbursement

1715 WordsMar 28, 20177 Pages
Business and Legal Considerations for the AGACNP Reimbursement Issues The adult-gerontology acute care nurse practitioner (AGACNP) has many responsibilities. In addition to providing excellent patient care, the AGACNP must also know how to code for patient services, bill appropriately and know how much they should expect in reimbursement for specific treatments. Many legal issues arise for the AGACNP, including several forms of negligence; the AGACNP should be educated on the essential elements. Finally, the AGACNP must educate themselves and be prudent to avoid legal issues related to malpractice. In the following paragraphs, each of these issues will be discussed. The current procedural terminology (CPT) coding system was first created…show more content…
If both the physician and the AGACNP see the patient face to face then Medicare may be billed as, incident to, for reimbursement (Medicare Learning Network, 2016). The AGACNP will be reimbursed for services performed at 85% of what the physician is paid under the Medicare Physician Fee Schedule (Medicare Learning Network, 2016). Medicaid reimbursement is dependent on the state in which you are practicing, each state controls Medicaid individually (Dillon & Hoyson, 2014). In Florida, the AGACNP must practice in collaboration with a physician (Florida Medicaid, 2014). The AGACNP can expect to be reimbursed for 80% of the physician rate (Florida Medicaid, 2014). If the AGACNP is a first assistant to the physician in surgery, then their reimbursement is 12.8% of the physician rate (Florida Medicaid, 2014). Fee for service indemnity plans are essentially health insurance plans in which the consumer may choose any provider or hospital that they want to use; however, these plans are typically more expensive than other plans (Mukherji & Fockler, 2014). The fee for service plans pay only for services rendered, typically using the CPT coding system (Reimbursement, 2016). The indemnity plans will require the provider to bill the insurance company for services rendered (Zuvekas & Cohen, 2016). Typically, the insurance company will pick up 80% of the patient’s bill and the patient is responsible for the other 20% (Zuvekas &

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