Welcome to the "wonderful world" of health care finance! This self-instructional module assists you, Advanced Practice Nurses (APNs), in understanding many complex issues associated with health care financing in the United States. You can apply these vital skills and design strategies for maximizing your reimbursement in practice.
This module assists APNs in developing a plan to obtain Medicare, Medicaid, and private payer reimbursement. You will:
- Learn about some of the history and vocabulary of reimbursement structures.
- Visit actual professional and governmental web sites dealing with health care reimbursement.
- Explore the critical link between coding, documenting of care, and reimbursement.
1. Key Reasons APNs Must Know About Reimbursement
2. Questions for APNs to Ask about Reimbursement
3. Current Trends Regarding Reimbursement Costs
4. The Politics of APN Reimbursement
5. The Language of Reimbursement
6. Quiz Yourself on the Language of Reimbursement
7. Timeline of Reimbursement Laws and Regulations
8. Reimbursement Entities
9. Reimbursement Issues Specific to Minnesota
10. Current APN Issues Regarding Reimbursement
11. How Are APNs Reimbursed in these Systems?
12. Advantages of Direct APN Reimbursement
13. Difficulties of Managed Care Reimbursement
14. APN Strategies to Obtain Reimbursement
15. Pricing Strategies for Health Care Reimbursement
16. Documenting to Obtain Maximum Reimbursement
17. Billing Systems and Components
18. Monitoring APN Productivity in Practice
The primary resource reference for this module is: Hickey, J.V., Ouimette, R.M. & Venegoni, S.L. (2000). Advanced practice nursing: changing roles and clinical applications. (2nd edition) Philadelphia: Lippincott.
LINKS TO REIMBURSEMENT RELATED WEBSITES:
Web sites are located throughout the module, which will give you opportunity to read other material and viewpoints on reimbursement related to APN practice.
This learning module has been developed through funds provided by the Collaborative Rural Nurse Practitioner Project. The Collaborating Minnesota Schools of Nursing include: College of St. Catherine, St. Paul; College of St. Scholastica, Duluth; University of Minnesota, Minneapolis; Winona State University, Rochester; Minnesota State University, Mankato; and Metropolitian State University, St. Paul. The Collaborative Rural Nurse Practitioner Project is funded by the Minnesota office of Rural Health and Primary Care.
The content for this module was developed and authored by Linda Lindeke, PhD, RN, CNP, Assistant Professor, School of Nursing, University of Minnesota.
If you experience any problems with this website please contact the Collaborative Rural Nurse Practitioner Project Office at 1-800-597-8636 or e-mail Kim Klose.