Week 8 Incident-to Discussion Board Paper
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
Week 8 Incident-to Discussion Board Paper
For this week’s discussion board I chose the topic of “incident-to” billing, as known as shared billing. Though I pulled information from multiple articles to define and discuss the topic of incident-to billing, the main article, for the purpose of this assignment is from Carolyn Buppert entitled “‘Incident-to’ Billing Explained.
Who Uses It, When, and Why?”. Incident-to billing is defined as services that can be billed at the physician’s higher rate of reimbursement, though the services were provided by someone other than the physician, such as the nurse practitioner (NP), physician’s assistant (PA), and even the staff nurse, depending on if a certain criterion has been met (Buppert, 2016a).
Summary of Article
The article by Buppert (2016a) touches on the topic of Incident-to billing per the Medicare criteria. The article explains that when the outlined criteria are met, billing can be placed under the national provider number (NPI) of one provider, though services were provided by another person.
Most circumstances of incident-to billing may be looked upon as if the physician is taking the credit for the work and skills that were provided by the NP/PA, allowing for them to get less of the accolades for the work and maybe even discounting the NP/PA’s judgment and the care that they are providing because the reimbursement is at a discounted rate.
This interpretation of the NP/PA’s judgment and care is unfounded. Hooker and Muchow (2015) report that the care of the NP/PA has been proven to be better than that of the physician in some circumstances, with the added bonus of it being less expensive (Kenny, 2016).
Collaborative versus Independent
The NP/PA in my state, North Carolina, must work in collaboration with a physician. The higher reimbursement can be billed if the visit is in an office setting, documentation of participation from the physician is provided with a note that the physician reviewed the plan of care, and if the NP/PA provides care to a patient that the physician had previously established a plan of care (Painter & Painter, 2018).
Another way collaborative care can be billed on a higher reimbursement level is by using current procedural terminology (CPT) codes (Hughes, 2017). An example of CPT usage is that of an example provided in the article by Buppert (2016a), this is when the NP has seen the patient for a blood pressure issue and asks the patient to return for a blood pressure check at a later date. The patient will return to have the blood pressure checked by the clinic nurse, allowing for the NPI number of the NP to be used for higher reimbursement. In states that do not require collaboration with a physician, billing will obviously be regulated differently.
Legal and Ethical Implications
From all the references that I have read and some of those are listed below, it appears that fraudulent billing is typically the most common issue. Physicians or the financial billing department of a facility could possibly code visits at the higher reimbursement, though the physician may not have had a true hand in the care of the patient.
The biggest thing I have taken away from this assignment is the importance of protecting your name and credentials (Buppert, 2016b). The NP must take great care in protecting their NPI as it can be used falsely in billing. The repercussions of this falsification can result in legal ramifications against the NP.
Buppert, C. (2016a). Incident-to billing explained: Who uses it, when, and why?. Medscape. Retrieved April 12, 2020, from https://www.medscape.com/viewarticle/869335#vp_1
Buppert, C. (2016b). Legal limits: 3 ways to protect your career. Journal for Nurse Practitioners, 12(8), 575–576. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2016.06.010
Hooker, R.S. & Muchow, A.N. (2015). Modifying state laws for nurse practitioners and physician assistants can reduce cost of medical services. Nursing Economic$, 33(2), 88–94.
Hughes, C. (2017). Coding & Documentation. Family Practice Management, 24(2), 36.
Kenny, C. (2016). Physician Incident-to Billing and Shared Services. Dennis Barry’s Reimbursement Advisor, 31(7), 3–6.
Painter, R, & Painter, M. (2018). NP, PA incident-to billing: What is (and isn’t) allowed. Urology Times, 46(7), 31.
Week 8 Incident-to Discussion Board Paper
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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