Regulatory & Coding Compliance for APRNs Cont.

Posted: December 1st, 2022

 

Regulatory & Coding Compliance for APRNs Cont.

 

this is a family nurse practitioner provider program and will need powerpoint to be developed by first national legal and standards of care and by Texas nurse practitioners standards of care, When providing health care, there are standards of care which a reasonably prudent provider should follow. Providers at all levels are held to these standards of care. Failure to provide competent care to your patients will put you at risk for malpractice. Remaining current with the evidenced-based guidelines and providing optimal care will minimize the risk of liability.Regulatory & Coding Compliance for APRNs Cont.
For this Assignment, you will create a PowerPoint presentation that explains any legal implications that exist for failure to adhere to a standard of care, the key elements of malpractice, and compare the differences in malpractice policy options.Regulatory & Coding Compliance for APRNs Cont.

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To prepare:
Consider the importance of using professional resources such as the National Guideline Clearinghouse to guide care delivered
Create a PowerPoint presentation no more than 15 slides in length that addresses the following:
Explain, in your own words, what regulatory and coding compliance for APRNs means to your practice
Compare coding compliance issues within the state you intend to practice and federal regulations
Identify and explain any legal implications that exist for failure to adhere to a standard of care
Identify and explain the key elements of malpractice
Compare the differences in malpractice policy options

Regulatory & Coding Compliance for APRNs Cont.

uIntroduction

uStandards of care:

uEstablished practices accepted as proper in healthcare sector

uUsed to guide practice

uFailure to adhere leads to malpractice

uThe presentation covers

uRegulatory & coding compliance for APRNs

uCoding compliance

uFailure to adhere to standards of care

uKey elements of malpractice

uComparison of malpractice options (Peterson, 2017).

uRegulatory & coding compliance for APRNs Cont.

uCompliance with regulations and coding for APRNs:

uFacilitates payment for services

uProtects their licenses

uFailure for an APRN to comply leads to:

uLoss of funds

uCharged for false claims

uLawsuits filed against APRNs (Ortiz et al., 2018).

u

uRegulatory & coding compliance for APRNs

uDocumentation should support all billed codes for every visit

uInsufficient documentation can lead to Medicare audit resulting to:

uCriminal prosecution

uFines

uloss of license

uLoss of Medicare provider status (Ortiz et al., 2018).

u

u

uCoding Compliance Issues in Texas

uTexas Board of Nursing licenses nurse practitioners (NPs)

uAPRN licensure may/may not consist of prescriptive authority

uState law in Texas requires NPs:

uNPs not allowed to practice independently

uCareer-long supervision by designated physicians

uDelegation by physicians to provide patient care

uNPs can directly bill for the provided services using their national provider identifiers (NPIs)

uSupervising physician can also bill the services provided by NPs (Peterson, 2017).

uLegal implications for failure to adhere to standards of care

uThe nurse violates standard of care thus leads to malpractice

uThe nurse can experience liability for negligence if harm occurs for the patients

uLiable for negligence lawsuit for failing to comply with state regulations and hence result to legal liability

uPatient can forward individual injury laws suits if the healthcare provider does not comply with care standards (Ortiz et al., 2018).Regulatory & Coding Compliance for APRNs Cont.

u

uKey elements of malpractice

uElements of malpractice include:

uDuty

uBreach of duty

uHarm

uCause (Kadivar et al., 2017).

uDuty as an Element of Malpractice

uA malpractice may occur if the healthcare provider owes the patient a duty of care

uThere should be a healthcare provider-patient relationship for the duty to exist

uThere should be expected standard of care on safety, conforming with the clinical guidelines, proper documentation & confidentiality

uBreaching the duty leads to malpractice (Kadivar et al., 2017).Regulatory & Coding Compliance for APRNs Cont.

uBreach of Duty as an Element of Malpractice

uThe healthcare provider violates the duty of care if they fail to provider the required level of care

uThe quality of care should be equivalent to that of another professional in equivalent specialty & similar situation

uViolation of duty happens when the required standards of care or the agreement between the practitioner and patient are not followed (Hågensen et al., 2018).Regulatory & Coding Compliance for APRNs Cont.

uHarm as an Element of Malpractice

uMalpractice occurs if the patient experiences any harm due to breach of duty

uMedical malpractice can result to emotional, physical or financial harm

uThe effect of the violation of the owed duty important in identifying the harm caused

uMedical malpractice resulting to harm can lead to a lawsuit against the responsible healthcare practitioner (Hågensen et al., 2018).Regulatory & Coding Compliance for APRNs Cont.

uDirect Cause as an Element of Malpractice

uThere should be evidence to show the breach of duty by the healthcare provider caused the patient harm

uMalpractice occurs if the patient experiences any form of harm under the care of the healthcare provider

uThe violation of duty involves various related events that cause harm to the patient resulting to malpractice

uHarm very important in determining a medical malpractice (Raveesh et al., 2016).Regulatory & Coding Compliance for APRNs Cont.

uDifferences in Malpractice Policy Options

uMedical malpractice insurance/policy important in case of a malpractice case

uPolicies different in terms of premium costs and the costs based as per the specialty of the practitioner and practice location

uSome policies do not cover some medical procedures

uPractitioners need to be aware of the malpractice options that include:

uClaims made

uOccurrence claims (Barnes et al., 2017).

uClaims Made Policies

uProvide coverage for the insured incidents occurring on or after the indicated policy date

uMost common type of medical malpractice policy

uVaries between insurance carrier & dependent on the reported claims

uProvides insurance against claims reported following the end of the original policy period for all events that took place when the policy was in effect (Barnes et al., 2017).Regulatory & Coding Compliance for APRNs Cont.

uOccurrence claims

uInsures against the insured events occurring during the policy period

uRisky and not regularly provided for medical malpractice claims (Barnes et al., 2017).

u

uIntroduction

uStandards of care:

uEstablished practices accepted as proper in healthcare sector

uUsed to guide practice

uFailure to adhere leads to malpractice

uThe presentation covers

uRegulatory & coding compliance for APRNs

uCoding compliance

uFailure to adhere to standards of care

uKey elements of malpractice

uComparison of malpractice options

uRegulatory & coding compliance for APRNs Cont.

uCompliance with regulations and coding for APRNs:

uFacilitates payment for services

uProtects their licenses

uFailure for an APRN to comply leads to:

uLoss of funds

uCharged for false claims

uLawsuits filed against APRNs

u

uRegulatory & coding compliance for APRNs

uDocumentation should support all billed codes for every visit

uInsufficient documentation can lead to Medicare audit resulting to:

uCriminal prosecution

uFines

uloss of license

uLoss of Medicare provider status

u

uCoding Compliance Issues in Texas

uTexas Board of Nursing licenses nurse practitioners (NPs)

uAPRN licensure may/may not consist of prescriptive authority

uState law in Texas requires NPs:

uNPs not allowed to practice independently

uCareer-long supervision by designated physicians

uDelegation by physicians to provide patient care

uNPs can directly bill for the provided services using their national provider identifiers (NPIs)

uSupervising physician can also bill the services provided by NPs

uLegal implications for failure to adhere to standards of care

uThe nurse violates standard of care thus leads to malpractice

uThe nurse can experience liability for negligence if harm occurs for the patients

uLiable for negligence lawsuit for failing to comply with state regulations and hence result to legal liability

uPatient can forward individual injury laws suits if the healthcare provider does not comply with care standards

u

uKey elements of malpractice

uElements of malpractice include:Regulatory & Coding Compliance for APRNs Cont.

uDuty

uBreach of duty

uHarm

ucause

uDuty as an Element of Malpractice

uA malpractice may occur if the healthcare provider owes the patient a duty of care

uThere should be a healthcare provider-patient relationship for the duty to exist

uThere should be expected standard of care on safety, conforming with the clinical guidelines, proper documentation & confidentiality

uBreaching the duty leads to malpractice

uBreach of Duty as an Element of Malpractice

uThe healthcare provider violates the duty of care if they fail to provider the required level of care

uThe quality of care should be equivalent to that of another professional in equivalent specialty & similar situation

uViolation of duty happens when the required standards of care or the agreement between the practitioner and patient are not followed

uHarm as an Element of Malpractice

uMalpractice occurs if the patient experiences any harm due to breach of duty

uMedical malpractice can result to emotional, physical or financial harm

uThe effect of the violation of the owed duty important in identifying the harm caused

uMedical malpractice resulting to harm can lead to a lawsuit against the responsible healthcare practitioner

uDirect Cause as an Element of Malpractice

uThere should be evidence to show the breach of duty by the healthcare provider caused the patient harm

uMalpractice occurs if the patient experiences any form of harm under the care of the healthcare provider

uThe violation of duty involves various related events that cause harm to the patient resulting to malpractice

uHarm very important in determining a medical malpractice

uDifferences in Malpractice Policy Options

uMedical malpractice insurance/policy important in case of a malpractice case

uPolicies different in terms of premium costs and the costs based as per the specialty of the practitioner and practice location

uSome policies do not cover some medical procedures

uPractitioners need to be aware of the malpractice options that include:

uClaims made

uOccurrence claims

uClaims Made Policies

uProvide coverage for the insured incidents occurring on or after the indicated policy date

uMost common type of medical malpractice policy

uVaries between insurance carrier & dependent on the reported claims

uProvides insurance against claims reported following the end of the original policy period for all events that took place when the policy was in effect

uOccurrence claims

uInsures against the insured events occurring during the policy period

uRisky and not regularly provided for medical malpractice claims

 

Regulatory & Coding Compliance for APRNs Cont.