Credentialing Case Study

Problem Significance
A good understanding of billing and coding and a review of common errors in audits will help a practice sustain and thrive. According to Stewart (2016), providers may feel passionate about their practice model and patients, but “failing to recognize how a changing financial landscape affects the bottom line is hazardous to a practice’s survival” (p.1). Credentialing is the practice of checking the credentials of a health care provider and practice. Credentialing is performed by insurance company prior to entering a contract with a provider. A nurse practitioner also needs to contract with insurance companies. These contracts identify prospective payments for procedures and examinations. They establish the guidelines …show more content…
3). Time based codes require careful documentation of time spent and summary of discussion. Reimbursement for evaluation and management services is often challenging for primary care providers as most common evaluation and management codes are based on location, patient status and level of service (Enos, 2016). Managing revenue appropriately in a medical practice is critical to the practice’s success. According to Lowes (2004), reimbursement from government payers is projected to continue to decline and third- party payers with fee for service contracts gain more leverage therefore managaing revenue effectively will be paramount for practice. The nurse practitioner needs to have a thorough knowledge and understanding of billing and coding to be able to survive in current healthcare which is continuously …show more content…
We are currently on the 10th version of the ICD coding system. The ICD system divides into body systems, diseases, and injuries. The ICD-10 codes may have from 3 to 7 characters (Burgos, Johnson, & Keogh, 2007).
Nurse Practitioner Billing
Nurse practitioners may bill their patients in two ways. With independent billing, the patient is scheduled and billed under the National Provider Identification (NPI) number of the NP providing the care. In incident-to billing, the patient may be scheduled under the physician or NP, but the bill is submitted using the physician’s NPI number. The physician is able to be reimbursed at a higher rate than a nurse practitioner alone.

Regulating bodies Center for Medicare and Medicaid Services provides services to many Americans. These programs provide healthcare to the poor, disabled, and elderly. The policies established by these bodies help shape healthcare reimbursement in other entities. Their goal is to maximize benefits to patients and decrease costs to the taxpayer. Medicare requires claims to be sent within 12 months and specific claim processing rules to be followed (Smiley, 2015). Many insurers base their policies after CMS suggestions but are not required to do

Show More

Nt1310 Unit 3 Case Study 1

NUR598 Magnet Certification Essay example

Cardiovascular Technician Essay

Nursing Across the Ages Essay

Texas Health Harris Methodist-Cleburne Case Study Summary

Xacc/280 Week 9 Final Paper

Being A Cardiologist Essay

Psychiatric Nursing Career Paper

Essay on Health Information Technology and its Place in Federal Programs

What Is Managing In Contemporary Organization