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Running head: MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES 1
Medicare Documentation and Reimbursement Issues
Name
Institution
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
2
Table of Contents
INTRODUCTION…………………………………………………………………………………………………………. 3
DESCRIPTION OF THE ISSUE …………………………………………………………………………………… 3
Qualifications…………………………………………………………………………………………………………….. 3
Process of care …………………………………………………………………………………………………………… 4
ANALYSIS OF THE ISSUE ………………………………………………………………………………………….. 6
Identification of restrictions ……………………………………………………………………………………….. 6
SIGNIFICANCE OF THE ISSUE …………………………………………………………………………………. 8
Conclusion ……………………………………………………………………………………………………………………. 9
References …………………………………………………………………………………………………………………… 10
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES 3
INTRODUCTION
Medicare documentation is an important aspect of health care in relation to the quality of
care. The validity of health records depends on accuracy and preciseness that the practitioners
have put in the development of records. Provision of accurate documentation is the responsibility
of the practitioners. Some of the advantages of accurate documentation for health records include
a guarantee of integrity, the safety of the patient, as well as protecting the care providers.
Documentation ensures integrity in the sense that the payers will have a piece of clear
information about the correct amount that they ought to pay and that the amount is paid to the
correct people (Barnes et al., 2017). The concept of safety comes about quality of care, which
ensures that the patients are served well according to their needs. Protection for the providers as
the proper documentation will guard them against fraud and other forms of liabilities. (Barnes, et
al., 2017) This paper explains the role of nurse practitioners at Rio Grande Valley in Texas. The
paper elaborates the background of the policies that affect the operation of Nurse Practitioners at
the state and federal level. It also presents the analysis of the issue as well as the significance of
the issue.
DESCRIPTION OF THE ISSUE
Qualifications
There are two critical aspects of the standard of practice of Nurse Practitioners, which
include their qualifications and the process of care. Nurse Practitioners are a group of personnel
that is trained and licensed to offer primary nursing care to patients and keep good medical
records for the patients (American Association of Nurse Practitioners, 2019). The essentials of
medical care documentation and reimbursement include consistency, up-to-date, and complete
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
4
record. The current states and mode of operation of Nurse Practitioners in Texas state are that
they are restricted and denied the right to experience their credentialism (Cdn.ymaws.com,
2019). Note that the role of Nurse Practitioners is to provide smart and primary care in both
remote and compromised areas. The Nurse Practitioners have specialized education that gives
the ability to perform their procedures in varied environments (American Association of Nurse
Practitioners, 2019). The Texas Nursing practice act requires that the Nurse Practitioners ought
to have a consent which can be used as a collaborative agreement. A physician writes the
agreement in the level of a supervisor.
The nature of treatment for Nurse Practitioners in Texas is a crucial issue to look into in
order to improve the quality of care. There should be more education provided to Nurse
Practitioners regarding their role in order to increase the level of satisfaction and as well as the
outcomes in comparison with the practitioners (American Association of Nurse Practitioners,
2019). The issues of Nurse Practitioners are also essential and attract advocacy for the freedom
and independence of the Nurse Practitioners in practice.
Process of care
The Nurse Practitioners are granted access to the use of scientific approaches as well as
the national standards laid out for patient care management. The process of care has different
components that include health status assessment, diagnosis, creation of a good treatment plan,
implementation of the treatment plan as well as the making of follow up to evaluate the status of
the patient (Barnes et al., 2017). Every component has different aspects that are undertaken by
the Nurse Practitioners in order to provide the best quality of primary care to their patients
(Peterson, 2017). The health status assessment of the patient entails activities such as obtaining
the medical history and other important information about issues that might be the cause of
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
5
factors that compromise the health of the patient. The Nurse Practitioners also perform the
primary examination of the patient making use of the demographics such as age to trace the
patient’s medical history. Assessing the history of the patient helps the Nurse Practitioners to be
able to identify the medical risks that the patient is going through.
The second component that entails diagnosis is vital in the operation of Nurse
Practitioners. Nurse Practitioners utilize different skills, such as critical thinking to be able to
analyze the information that is provided by the patient. Nurse Practitioners are entrusted to make
informed decisions that will be helpful during the development of a treatment plan (Peterson,
2017). At the point of diagnosis, the Nurse Practitioners formulate differential diagnosis that is
based on the information extracted from the history and physical examination of the patient
(Peterson, 2017). The practitioners can then establish priorities to govern the development of a
treatment plan. The process of care, therefore, depends on proper documentation as well as the
knowledge of the Nurse Practitioner (Peterson, 2017). Due to the demand for quality, Nurse
Practitioners under a high level of training to be able to have the capacity to undertake their
demanding tasks.
The operation for Nurse Practitioners is a unique approach to strengthening the health
care sector. It is essential to the health of a nation as it increases access to health care. The
operation of Nurse Practitioners in the health sector is effective and cost-effective (Peterson,
2017). Therefore, the state and federal legislation ought to enact laws that strengthen the
operations of Nurse Practitioners rather than enacting laws that shrink the operation of Nurse
Practitioners, as many will be discouraged.
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
6
ANALYSIS OF THE ISSUE
Many patients have problems accessing care. The introduction of qualified Nurse
Practitioners in the health care system came as a relief to the situation. The Nurse Practitioners
operation enhanced the provision of quality care that is cost effective (Barnes et al., 2017).
However, the Nurse Practitioners operation and roles are negatively impacted by the regulations
that are directed by governmental bodies (Barnes et al., 2017). The government bodies in Texas
have consistently ignored legislations, which are meant to strengthen the operations of Nurse
Practitioners by reinstating their roles. In order to analyze the effects of the issue to the roles of
Nurse Practitioners, processes such as identification of restrictions and the scope of operations
would be helpful.
Identification of restrictions
The role of regulation of Nurse Practitioners is mandated to individual states. Some states
have adopted the full practice of Nurse Practitioners as provided by AANP, while others have
either reduced or restricted practice. For the reduced practice states, Nurse Practitioners are
allowed to engage in only one element of the Nurse Practitioner practice. Nurse Practitioners are
regulated through a collaborative agreement (Peterson, 2017). For the restricted practice states,
Nurse Practitioners are allowed to engage in only one of the Nurse Practitioner practice but
under supervision. The Texas state has adopted the collaborative agreement that restricts the
operations of Nurse Practitioners (Peterson, 2017). The regulations by the collaborative
agreement deny the Nurse Practitioners the capacity to exercise their full skills in practice
according to the capacity of their training and education. Since Nurse Practitioners are well
trained, their operation would be a great relief to health issues where primary care is required,
especially in remote settings.
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
7
The Nurse Practitioners in Texas struggle for independence despite them being useful in
the event of a shortage of nurses. They are limited by the collaborative agreements since the
agreements are expensive (Barnes et al., 2017). The Nurse Practitioners feel restricted and denied
natural ability to be able to prescribe treatment as well as the ability to make independent
decisions about their clients (American Association of Nurse Practitioners, 2019). Nurse
Practitioners are discouraged by regulations when they attempt to start an independent practice.
Some want to start the independent practice at a young age, which they end up not starting it.
The Nurse Practitioners in Texas express the negativity of the collaborative agreement
regulations and the yearn for the national authority for practice.
The role of the Nurse Practitioners is underrated in Texas because they are restricted even
after being licensed whereas the Physicians have full rights to exercise and practice medicine
with almost immediately from the time when they are licensed. The regulations discourage most
of the Nurse Practitioners and that some even wish to quit (Peterson, 2017). The develop an
inferiority complex over their skills that they are not able to exercise or put the skills gained
through education and training into practice. They develop a feeling that they are renders of less
service by the regulations despite the quality of their training (Peterson, 2017). The collaborative
practice agreement is expensive to the Nurse Practitioners, and most of them are not able to
afford the requirements of the agreement. Nurse Practitioners lack continues development of
their careers as the regulations allow them to exercise only one area of Nurse Practitioner
practice (Peterson, 2017). The collaborative agreement also restricts the Nurse Practitioners
from engaging in activities like research and monitoring of the process. Instead, if Nurse
Practitioners need to take part in research, they have to look for a physician in order to
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
8
collaborate despite the fact that the operations will be under the Nurse Practitioners’ license and
certification.
SIGNIFICANCE OF THE ISSUE
The future of health care in Texas is going to be demanding due to high population
growth. The community needs over quality, and cost-effective care is an increase in demand
every dawn. The regulations over the practice of Nurse Practitioners ought to be revised in the
future. The legislature for Texas state as well as the federal government of Rio Grande Valley
ought to pass the legislation on moving forward to the adoption of full Nurse Practitioners
practice (Peterson, 2017). Research indicates that Texas state has poor performance with regard
to health due to the restrictions sanctioned on the practice of Nurse Practitioners (Peterson,
2017). The state government ought to consider the advantages that Nurse Practitioners have over
the physicians. Nurse Practitioners have the likelihood of being able to work in a rural setting
than physicians.
APRNs should create an educational platform to shed light on the advantages of engaging
in a full practice by Nurse Practitioners (Peterson, 2017). Some of the positive information
include the fact that research done on the work of the Nurse Practitioners has all shown
reasonable indications that the presence of the Nurse Practitioners in the health sector have
improved the quality of care and their services are cost-effective and every citizen can afford.
According to Peterson (2017), the sanctions on the Nurse Practitioners practice might
force the Nurse Practitioners to consider reorganizing their expenditures to attract more value for
service provision. Therefore, the state and the federal government have an obligation to find a
solution and a better way to engage the Nurse Practitioners (Peterson, 2017). The two
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
administrations ought to legislate laws that ensure that the Nurse Practitioners receive a full
reimbursement as they provide services at the occurrence of the different incidence. The future
research opportunities over the operation of the Nurse Practitioners ought to look into the
implementation of full practice for Nurse Practitioners.
Conclusion
Nurse Practitioners are essential in the health care sector as they provide primary care
services at an affordable cost. The Texas state government will make a significant step if it can
embrace full practice for Nurse Practitioners as an agender for improving the quality of health
care in the state. Authorization of full practice of Nurse Practitioners will also help the state
government to curb the health needs of a growing population.
9
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
10
References
Aacn.nche.edu. (2019). The American Association of Colleges of Nursing (AACN). [online]
Available at http://www.aacn.nche.edu/membership/membersonly/presentations/2013/13spring/Cahill.pdf
http://onlinelibrary.wiley.com/doi/10.1111/j.1745-7599.2013.00812.x/pdf [Accessed 18
Jun. 2019].
American Association of Nurse Practitioners. (2019). Standards of Practice for Nurse
Practitioners. [online] Available at
http://www.aanp.org/images/documents/publications/standardsofpractice.pdf [Accessed
18 Jun. 2019].
American Association of Nurse Practitioners. (2019). Your Partner in Health, The Nurse
Practitioner. [online] Available at http://www.aanp.org/publications/np-brochure
[Accessed 18 Jun. 2019].
Barnes, H., Maier, C. B., Altares Sarik, D., Germack, H. D., Aiken, L. H., & McHugh, M. D.
(2017). Effects of Regulation and Payment Policies on Nurse Practitioners’ Clinical
Practices. Medical care research and review: MCRR, 74(4), 431–451.
doi:10.1177/1077558716649109
Cdn.ymaws.com. (2019). 2017 Nurse Practitioner Core Competencies. [online] Available at
https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreCo
mps_with_Curric.pdf [Accessed 18 Jun. 2019].
Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner
Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
MEDICARE DOCUMENTATION AND REIMBURSEMENT ISSUES
11
LEARNING POWERPOINT PRESENTATION
– Medicare Documentation & Reimbursement Issues (Incident to) & the NP role
Learning Presentation-Grading Criteria
Points
Possible
1. Description of the issue (background; current status, current policy, local, state,
20
or federal agencies that regulate or enforce practice, etc.)
25
2. Analysis of the issue (effect on the NP role, health care, patient outcomes, etc)
3. Significance of the issue (future concerns, local effect, potential for research
opportunities, etc.)
4. PowerPoint presentation professional (not read) & succinct Oral
presentation LIMITED to 15 slides)
5. Followed the GENERAL GUIDELINES FOR WRITTEN ASSIGNMENTS
on pg 7 LIMITED to no more than 4-6 pages
TOTAL
20
20
15
100
Points
Earned

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