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Family Nurse Practitioner (FNP) > CHAPTER 21- Reimbursement for Nurse Practitioner Services > Flashcards

CHAPTER 21- Reimbursement for Nurse Practitioner Services Flashcards

Fiscal responsibility is paramount for NPs to understand. Study these concepts with these flashcards.

1
Q

It is important for the FNP to understand coding for all of the following reasons EXCEPT:

  1. Maintain fiscal responsibility.
  2. Calculate a raise.
  3. Add revenue to a practice.
  4. Decrease liability.
A

2. Calculate a raise.

Coding has nothing to do with a raise, which is part of the employment agreement.

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2
Q

The CPT is known as which of the following?

  1. Common Physician Terminology
  2. Current Physical Terminology
  3. Current Procedural Terminology
  4. Common Procedural Terminology
A

3. Current Procedural Terminology

It is published by the American Medical Association.

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3
Q

Who can bill using the CPT?

  1. MD, PA, NP, RN
  2. MD, NP, MA
  3. MD, PA, NP, PT
  4. MD, PA, NP
A

4. MD, PA, NP

Only medical doctors, physician assistants, and nurse practitioners can bill for their services and be reimbursed.

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4
Q

What is NOT true of the CPT?

  1. Updated monthly
  2. Lists procedures and codes
  3. Has an appendix of coding examples
  4. Owned by the AMA
A

1. Updated monthly

The CPT is updated annually.

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5
Q

In 1997, President Bill Clinton signed the _________, which allows FNPs to be reimbursed.

  1. Balanced Bill Act
  2. Balanced Budget Act
  3. Balanced Budget Alliance
  4. Balanced Bill Alliance
A

2. Balanced Budget Act

In 1997, President Clinton signed the Balanced Budget Act into law which allowed for reimbursement of nurse practitioner services.

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6
Q

The signed legislation mentioned in the previous question allows NPs to be reimbursed at what percentage?

  1. 65%
  2. 75%
  3. 85%
  4. 100%
A

3. 85%

The BBA of 1997 allowed for nurse practitioners to be reimbursed at 85% of the physician reimbursement rate.

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7
Q

The resource-based relative value scale replaced ______ as a method of reimbursement.

  1. fee for service
  2. cost balance
  3. bartering
  4. value-based
A

1. fee for service

The resource-based relative value scale replaced the fee for service method of reimbursement.

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8
Q

ICD (International Classification of Diseases) was developed by which of the following?

  1. HOW – Health Organization of the World
  2. HHS – Health and Human Services
  3. WOD – World Organization of Diseases
  4. WHO – World Health Organization
A

4. WHO – World Health Organization

World Health Organization working with the United Nations. Started in 1860 when Florence Nightingale wanted to keep data on hospitals.

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9
Q

ICD provides all of the following EXCEPT:

  1. Morbidity data.
  2. Public health data.
  3. World drug data.
  4. Mortality data.
A

3. World drug data.

Classified diseases, symptoms, and injuries.

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10
Q

NPI stands for which of the following?

  1. National Provider Number
  2. National Provisionary Number
  3. Numerical Provider Number
  4. Numerical Physician Number
A

1. National Provider Number

Unique identifier recognized through passage of the Health Insurance Portability and Accountability Act (HIPAA) in 1996.

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11
Q

An NPI costs how much?

  1. $10
  2. $50
  3. $100
  4. Free
A

4. Free

There is no cost to apply for an NPI number.

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12
Q

The FNP must apply for a new NPI number if they change their practice to another state.

  1. True
  2. False
A

2. False

The NPI number is yours only and travels with you wherever you practice.

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13
Q

CMS stands for which of the following?

  1. Centers for Medicare and Medicaid Services
  2. Committee for Medicare Services
  3. Center for Medicine Services
  4. Center for Medicare and Medicaid States
A

1. Centers for Medicare and Medicaid Services

See www.cms.gov.

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14
Q

The medical record should do all of the following EXCEPT:

  1. Be complete and legible.
  2. Reflect what was done and why it was done.
  3. Be signed by the provider.
  4. Be co-signed by the MD of the FNP notes.
A

4. Be co-signed by the MD of the FNP notes.

Co-signature is not required by the MD for FNP documentation. The provider of record providing the service must sign the documentation.

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15
Q

What form must you sign in order to be credentialed on an insurance panel?

  1. Attestation form
  2. Regulatory form
  3. Affirmation form
  4. Declaratory form
A

1. Attestation form

The nurse practitioner will be required to complete an attestation form to verify that the information to the credentialing organization is correct.

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16
Q

An electronic health record should not _____________.

  1. contain templates
  2. contain macros
  3. replace good documentation
  4. use cut and paste for all visits
A

4. use cut and paste for all visits

The nurse practitioner must ensure that there is clear and accurate documentation at every visit.

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17
Q

All of the following are key components of documentation EXCEPT:

  1. Counseling.
  2. History.
  3. Medical decision making.
  4. Physical exam.
A

1. Counseling.

Not a key component. Counseling is considered when coding by time.

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18
Q

History includes which of the following?

  1. History of present illness
  2. Review of systems
  3. Past, Family, Social
  4. Financial
A

4. Financial

It may be required for payment but has nothing to do with coding a visit.

19
Q

Medications are part of the past history.

  1. True
  2. False
A

1. True

Medications are being taken by a patient already, so they are considered part of the past medical history.

20
Q

An established patient is one who is _____________.

  1. seen by the FNP for the first time
  2. seen by the FNP in follow-up
  3. seen by the FNP for pre-op
  4. seen by the MD for a first visit
A

2. seen by the FNP in follow-up

The FNP already has a relationship with the patient.

21
Q

Practice authority is governed by the states. The three types of practice authority include which of the following?

  1. Full practice
  2. Reduced practice
  3. Limited practice
  4. Restricted practice
A

3. Limited practice

The practice authority map is located at www.aanp.org and is based upon the FNP’s ability to diagnose, treat, and prescribe treatments under supervision (Restricted), collaboration (Reduced), or autonomously (Full).

22
Q

All of the following are true of Medicare EXCEPT:

  1. It is state-regulated.
  2. It is an entitlement for the elderly and disabled.
  3. It is for everyone starting at age 65.
  4. It is a federal program.
A

1. It is state-regulated.

Medicare is a federal program run by the federal government.

23
Q

A collaborative agreement is between an FNP and an MD.

  1. True
  2. False
A

2. False

Depending upon the practice authority, the collaborative agreement can be with an MD or FNP.

24
Q

An FNP forgot to chart information in the EMR when she saw the patient two days ago. She should _______________________.

  1. know it cannot be added in after the fact
  2. put today’s date on it and write that the omission was from the date of service and document it
  3. have IT override it so she can document what she omitted in that day’s note
  4. add it when she sees the patient the next time.
A

2. put today’s date on it and write that the omission was from the date of service and document it

This is the best way to handle an omission and the FNP should correct it as soon as it is known.

25
Q

There is a general multisystem examination and a single system examination form.

  1. True
  2. False
A

1. True

Single-system exam forms are for musculoskeletal, psychiatry, and cardiology, for example. More information can be found at www.cms.gov/medlearn.

26
Q

Which is NOT a single system examination?

  1. Cardiology
  2. Gastroenterology
  3. Musculoskeletal
  4. Psychiatry
A

2. Gastroenterology

Gastroenterology covers everything from the mouth to the anus, which is not a single system.

27
Q

Coding by time is used when greater than ___ of the visit is spent counseling or coordinating care.

  1. 40%
  2. 50%
  3. 75%
  4. 80%
A

2. 50%

This is used when the FNP is basing the visit on time and not the level of history, physical exam, or medical decision making.

28
Q

Incident to billing is for Medicare patients.

  1. True
  2. False
A

1. True

Though it may happen with other insurance carriers, “incident to” is rooted in Medicare regulations.

29
Q

Incident to billing is when the MD bills with the FNP provider number.

  1. True
  2. False
A

2. False

“Incident to” billing is when the FNP bills with the MD NPI number.

30
Q

Incident to requires the MD to be in the office but not necessarily see the patient.

  1. True
  2. False
A

1. True

The MD has to be available to the FNP for consultation or to answer questions.

31
Q

Incident to does not include which of the following?

  1. MD formulates treatment plan.
  2. MD signs FNP paycheck.
  3. Practice gets 100% reimbursement.
  4. Patient can have a new problem.
A

4. Patient can have a new problem.

The patient cannot have a new problem. If there is a new problem, the visit must be billed under the FNP NPI number.

32
Q

Medicare fraud is a costly problem. In a study published in 2010, how much revenue was billed fraudulently?

  1. Thousands
  2. Millions
  3. Billions
  4. Trillions
A

3. Billions

$6.2 billion dollars was fraudulently billed. This is why, as part of the Affordable Care Act, Recovery Audit Contractors are hired to investigate fraudulent billing practices.

33
Q

What can trigger an audit?

  1. Billing all visits using one code
  2. Collecting co-pays
  3. Billing non-covered services as covered
  4. Documentation does not support E&M billed
A

2. Collecting co-pays

Co-pay is a monetary agreement between the insured and the insurance company.

34
Q

What is the most common established patient code billed?

  1. 99212
  2. 99213
  3. 99214
  4. 99215
A

2. 99213

This is based upon a study done by the Department of Health and Human Services and the Office of the Inspector General looking at claims from 2000–2010.

35
Q

What is the code for an initial office visit for a 13-year-old with comedopapular acne unresponsive to over-the-counter treatment?

  1. 99214
  2. 99211
  3. 99202
  4. 99204
A

3. 99202

A new patient requires weighing history, physical exam, and medical decision making equally. A dermatology patient will have lower levels of visit codes. OTC treatment is not as risky as a prescription.

36
Q

What is the code for an office visit for a 32-year-old female established patient with new onset right lower quadrant pain?

  1. 99211
  2. 99202
  3. 99212
  4. 99214
A

4. 99214

Abdominal pain requires a workup, and being female could be GYN, GI, or GU etiology.

37
Q

What is the code for an office visit for a 60-year-old established patient with chronic hypertension on a multiple drug regimen who has come in for a blood pressure check?

  1. 99213
  2. 99204
  3. 99202
  4. 99215
A

1. 99213

An established patient with no change in medication.

38
Q

What is the code for an initial evaluation of a 70-year-old patient with recent onset confusion?

  1. 99202
  2. 99203
  3. 99204
  4. 99205
A

3. 99204

The elderly require an extensive workup to determine etiology, because a change in mental status could be neuro, GU, or medication related.

39
Q

What is the code for an office visit for an 82-year-old female established patient for a monthly B12 injection with a documented vitamin B12 deficiency?

  1. 99202
  2. 99211
  3. 99213
  4. 99203
A

2. 99211

B12 injections are given by an RN, which can be billed as a 99211.

40
Q

What is the code for an office visit for a 50-year-old female established patient with insulin-dependent diabetes mellitus who has come in for monitoring?

  1. 99211
  2. 99212
  3. 99213
  4. 99214
A

3. 99213

An established patient with a stable condition and no treatment plan change.

41
Q

What is the code for an initial office visit for a 33-year-old male with painless gross hematuria without cystoscopy?

  1. 99202
  2. 99203
  3. 99204
  4. 99205
A

2. 99203

A new patient requiring history, physical exam, and medical decision making weighed equally. The physical exam will keep the visit at 99203.

42
Q

What is the code for an office visit for a 10-year-old female established patient who has been swimming in a lake and has a one-day history of left ear pain with purulent discharge?

  1. 99211
  2. 99212
  3. 99213
  4. 99214
A

2. 99212

An established patient with localized body area and a problem-focused examination.

43
Q

What is the code for an office visit for the evaluation of recent onset syncopal attacks in a 70-year-old female established patient?

  1. 99212
  2. 99213
  3. 99214
  4. 99215
A

4. 99215

Any mental status change will require workup. Etiology can be neuro, cardiac, GU, or medication.

44
Q

The FNP is responsible for what is billed.

  1. True
  2. False
A

1. True

The provider of the service is responsible for what is documented and billed.

Family Nurse Practitioner (FNP) (22 decks)

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