Advanced Practice Registered Nursing: History, Milestones, and Regulations, Exams of Nursing

Download Advanced Practice Registered Nursing: History, Milestones, and Regulations and more Exams Nursing in PDF only on Docsity! Becoming APRN Quiz 1 Questions and Answers 2024 Nurse practitioner - role - Educated to practice independently at an advanced level to provide care; Address health promotion, disease prevention, health education and counseling as well as the diagnosis and management of acute and chronic diseases.; Provide initial, ongoing and comprehensive care to patients in family practice, pediatrics, internal medicine, geriatrics, and women's health. Practice in primary or acute care which have separate national competencies and unique certifications. (ANA, 2016) Milestone - 1965 - Dr. Loretta Ford: 1st NP (pediatrics specialty) & Dr. Henry Silver create 1st NP program at University of Colorado. - first recognized role/program Milestone - 1974 - ANA created Council of Primary Care NPs= 1st national certification exams - to become nationally recognized/certified Milestone - 2008 - APRN Consensus Model - 4 national specialties Milestone - 2016 - Full Practice Authority in the VA - any NP can fully recognize and can practice fully with no restrictions Milestone - 2020 - HHS Sec. Azar advises loosening restrictions in all states; CMS temporarily loosened restrictions on NP practice during pandemic, allows NP ordering of home health services LACE Model - Licensure, Accreditation, Certification, & Education Model. Developed in 2008 by the APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Collaboration among > 40 nursing organizations to address the inconsistency in APRN education, regulation, and practice which limited APRN mobility from one state to another - wanted standardization/uniformity for all programs. Standardization of licensure, accreditation, certification, and education aimed to improve access to APRN care. The result was the Consensus Model for APRN Regulation American Nurses Credentialing Center (ANCC) - Certifies FNP, PMHNP, AGPCNP, & AGACNP American Academy of Nurse Practitioners Certification Board (AANPCB) - Certifies FNP, AGPCNP & ENP American Association of Critical Care Nurses (AACN) - Certifies AGACNP Pediatric Nursing Certification Board (PNCB) - Certifies PPCNP & PPACNP National Certification Corporation (NCC) - Certifies WHNP & NNP Georgia, why does scope of practice matter? - National shortage of PCPs; GA did not expand access to Medicaid, rural hospitals have been closing, PCP shortage with GA ranking last in the number of physicians to citizens Scope of Practice Authority in GA - A written protocol is required between the NP and the supervising physician. The protocol specifies medical acts delegated by the physician and provides for immediate consultation with the physician. Ga. Rules & Regs. §410-11-.14; O.C.G.A. § 43-34-25. O.C.G.A. § 43-34-23. Any person practicing or offering to practice nursing or using the title "advanced practice registered nurse," as defined in O.C.G.A. §§ 43-26-1 et. seq. within the State of Georgia, shall be authorized as provided in O.C.G.A. §§ 43-26-1 et. seq. GA restrictions on NPs - NPs not recognized in state policy as PCPs; Can only order CT or MRIs in life threatening emergencies; NPs are not able to prescribe schedule 2 medications; NPI Number - what is it? Who provides it? Whats it for? - National Plan and Provider Enumeration System (NPPES) collects identifying information on health care providers & assigns each a unique NPI #. **National Provider Identifier (NPI) is a 10-digit identification number issued in US by Centers for Medicare and Medicaid Services (CMS). - A Health Insurance Portability & Accountability Act (HIPAA) Administrative Simplification Standard for remaining HIPAA compliant. a - Covered health care providers and all health plans and health care clearinghouses must use these NPIs in the administrative and financial transactions adopted under HIPAA. DEA Number - what is it? Why do yoes an NP need it? How much? - - NP who plans to administer, prescribe or dispense any controlled substance, you must be registered with the federal Drug Enforcement Administration (DEA). - In GA with a DEA number, the NP may prescribe regular prescriptions Schedule III-V controlled substance medications; but not Schedule II. - Under Georgia law, only physicians can prescribe Schedule II medications. - Without a DEA number, NP may not prescribe any scheduled drugs, but may only write regular prescriptions (such as antibiotics, etc.). - Costs: $731 for a three-year period. Renewal same amount. NP reimbursement - No federal laws define or limit how private insurers recognize or reimburse NP's. Important to know how commercial insurers want to be billed for NP services. NP's may be admitted to provider panel, or not admitted to panel but still allowed to provide services when billed under a physician name. Reimbursement may be full amount or reduced rate if billed under an NP's provider number. Some companies may not address NP's in the contract at all. In these cases, requesting written authorization or clarification on the provision and reimbursement of NP services is valuable SPLIT/SHARED SERVICE - what is it and how can it be billed - is an encounter where a physician and a NP each personally perform a portion of an Evaluation and Management (E/M) visit from the same practice. - Physician provided face-to-face portion with same patient. - E&M encounter with the patient, the service may be billed under the physician's or the APRN's NPI number. - You cannot split procedures and this is not allowed in SNFs. In the office/clinic setting, if the provider is in the office and they review the chart, you can bill under the provider Incident to billing - what is it? Who is included? - Medicare billing mechanism, allowing services furnished in an outpatient setting to be provided by auxiliary personnel & billed under the provider's NPI number. Under the supervisions provider's direct supervision and the axillary personnel can be a physician, nurse practitioner, clinical nurse specialist, physician's assistant, nurse midwife, and clinical psychologist: - The services provided must be in the area where care is delivered and supervising provider must be immediately available to provide assistance and supervision. - The provider must initiate a course of treatment & services done by the auxiliary staff include follow up care, and assisting in the plan of care. NP Medicare Conditions of Participation - NP is legally authorized & qualified to furnish services in the State where performed; Services are not otherwise precluded due to a statutory exclusion, and services are reasonable & deemed necessary; Services are the type considered physicians' services if furnished by a medical doctor or a doctor of osteopathy; You perform services in collaboration with a physician; Medicare may cover NP assistant-at-surgery services; Medicare may cover incident to services and supplies. Some examples per Medicare (AMA, 2019) - Taking the patient's history, performing a physical exam, and ordering appropriate laboratory tests and procedures; - Diagnosing, treating, and managing acute and chronic diseases; - Providing prescriptions and coordinating referrals; - Promoting healthy activities in collaboration with the patient Medicare Reimbursement guidelines for NPs - Medicare pays services at 80% of the lesser of the actual charge or 85% of the amount a physician gets under the Medicare Physician Fee Schedule (PFS); Payment is made directly to the NP for assistant-at-surgery services at 80% of the lesser of the actual charge or 85% of 16% of the amount a physician gets under the Medicare PFS; Medicare pays services furnished incident to the services of an NP in a setting outside of a hospital at 85% of the amount a physician gets under the Medicare PFS; When you bill directly for services to hospital inpatients and outpatients, payment is unbundled and made to the NP Medicaid reimbursement - Medicaid programs are administered by individual states, and state regulations on NP billing vary. State level restrictions: (Medicaid and/or Nurse Practice Act) can prevent NP's from performing certain procedures. GA requires collaborative agreement with a physician. NP who has a Medicaid provider number may bill Medicaid on a fee-for-service basis for physician services provided to a patient covered by Medicaid if patient is not enrolled with a managed care plan: - Medicaid reimbursement further complicated by many Medicaid recipients are enrolled in managed care plans (i.e. Wellcare & Peachstate). - In general, managed care plans reimburse only those providers admitted to the plan's provider panel. Some decline NPs on the panel. Commercial insurer NP reimbursement - Reimburse NPs on fee-for-service basis. Typically will have their own policy on the reimbursement of NP services such as: - reimbursing at the same rate as physician without requirement of being on panel - payment at a reduced rate, - payment for NP provided services when billed under physicians name, - denial of payment for NP services provided. - May adopt Medicare's rules and guidelines. Midwives - scope of practices - Can deliver infants, provide prenatal & postpartum care;