Capturing reimbursement for advanced practice nurse services in acute and critical care: legal and business considerations.

Advanced practice nurses (APNs) have been affected positively and negatively by recent changes in the way hospitals are financed. Among these changes are the shift from cost-based reimbursement to a prospective payment system and increased opportunities for billing APN services under the physician payment system. Positive effects include the need for hospitals to decrease the length of stay of hospitalized patients, leading to jobs for APNs who make the hospital course and discharge more efficient. Negative effects include budget shortfalls that lead to layoffs. This article explains the current financial landscape, including phenomena that are impeding the billing of APN services, and recommends adjustments so that the APN role will be on firm financial footing.

Third-party reimbursement for nurse practitioners' services on trauma teams: working through a maze of issues.

Third-party payers reimburse for physician services performed by nurse practitioners, if the services are within the scope of practice of a nurse practitioner and the payers' rules are followed. However, some hospitals and trauma services have been reluctant to bill the services of nurse practitioners they employ or to hire nurse practitioners, because the rules are complex, vary from payer to payer, can be difficult to find, and because operations are not always set up so that nurse practitioners' services are bundled in ways which conform to the rules. Medicare has developed detailed rules on billing nurse practitioners' services, but neither Medicaid nor commercial payers necessarily follow Medicare's rules. The situation is further complicated by wide variations in state law governing nurse practitioner scope of practice and requirements for physician collaboration. Despite all of these variables, it may be worth the time and effort to sort out the requirements for utilizing nurse practitioners and billing for their services, considering the limitations on residents' hours, the data on quality of nurse practitioners' clinical services and the potential for generating revenue. This article describes the legal and business issues, provides the general rules for billing nurse practitioners' services, and provides a plan for obtaining third-party payment for nurse practitioners' services on trauma teams.

Safeguarding patient privacy. Establish department compliance with new federal regulations on individually indentifiable health information.

New patient privacy standards require managers to rethink daily unit policies and procedures. Here's what you need to know to comply with the impending federal mandates.

Complying with patient privacy requirements.

By April 14, 2003, NPs must comply with new federal regulations that protect the privacy of patient health information. The government issued the regulations in response to several large-scale breaches of patient privacy. This article discusses how NPs can apply the regulations in an office-based practice or clinic, explaining the who, what, where, why, when, and how of the requirements. Using the sample consent, authorization, and notice forms, NPs can draft similar documents to ensure their compliance.