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Advanced Practice Nursing: Bundle Payments, CHIP, Role Strain, Medicare Part D Billing, Exams of Nursing

University of Buckingham (UB)Nursing

A comprehensive overview of key concepts and definitions related to advanced practice nursing, including bundle payments, chip, role strain, medicare part d billing, and various advanced practice nurse roles. It offers detailed explanations and answers to questions relevant to the field, making it a valuable resource for students and professionals seeking to deepen their understanding of advanced practice nursing.

Typology: Exams

2024/2025

Available from 04/15/2025

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Advanced Practice Nursing Questions
With Correct Detailed Answers.
Bundle Payments and health care expenditures - ANSWER- - Also known as bundle
payments
- Reimburstment of health care providers on the basis of expected cost for clinically
defined episodes of care
- "middle" ground between fee-for-service and capitation
- healthcare delivery system takes on financial risk of patient
- Forces system to enhance quality and coordination of care
- Incentivizes system to deliver care that truly meets the Triple Aim
CHIP - ANSWER- - Children's Health Insurance Program
- Health coverage to uninsured children whose families earn too much to qualify for
Mediciad but too little to afford private coverage
Role Strain - ANSWER- Subjective feelings of frustration, tension, or anxiety
expierenced in response to role stress & can be feelings of decreased self-esteem
when performance is below expectations
Role Conflict - ANSWER- Role expectations are percieved to be mutually exclusive or
contraditctory
Medicare Part D Billing - ANSWER- - Prescription drug coverage
- Must join a drug place to receive coverage under part D
- Coverage is attempt to lower prescription costs
- Payment is monthly fee that varies by plan & is addition to Part B premium or
inbedded in Part C premium
Role Stress - ANSWER- A situation of increased role performance demand (ex:
returning to school while maintaining work and family responsibilities or the expectation
of increased workload
Medicare Part B Billing - ANSWER- - Covers medical expenses such as physician and
outpatient care
- Direct reimbursement can only occur when submitting claim through part B
- Covers physician and nonphysical provider services, outpatient hospital services,
home health care not covered by part A (PT/OT) and other services such as diagnostic
testing, durable medical equipment and ambulance costs
- Enrollment in part B is voluntary to those receiving Part A
- Payment into system via monthly premiums that are established yearly based on
system expenses through deductibles & coinsurance programs
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Download Advanced Practice Nursing: Bundle Payments, CHIP, Role Strain, Medicare Part D Billing and more Exams Nursing in PDF only on Docsity!

Advanced Practice Nursing Questions

With Correct Detailed Answers.

Bundle Payments and health care expenditures - ANSWER- - Also known as bundle payments

  • Reimburstment of health care providers on the basis of expected cost for clinically defined episodes of care
  • "middle" ground between fee-for-service and capitation
  • healthcare delivery system takes on financial risk of patient
  • Forces system to enhance quality and coordination of care
  • Incentivizes system to deliver care that truly meets the Triple Aim CHIP - ANSWER- - Children's Health Insurance Program
  • Health coverage to uninsured children whose families earn too much to qualify for Mediciad but too little to afford private coverage Role Strain - ANSWER- Subjective feelings of frustration, tension, or anxiety expierenced in response to role stress & can be feelings of decreased self-esteem when performance is below expectations Role Conflict - ANSWER- Role expectations are percieved to be mutually exclusive or contraditctory Medicare Part D Billing - ANSWER- - Prescription drug coverage
  • Must join a drug place to receive coverage under part D
  • Coverage is attempt to lower prescription costs
  • Payment is monthly fee that varies by plan & is addition to Part B premium or inbedded in Part C premium Role Stress - ANSWER- A situation of increased role performance demand (ex: returning to school while maintaining work and family responsibilities or the expectation of increased workload Medicare Part B Billing - ANSWER- - Covers medical expenses such as physician and outpatient care
  • Direct reimbursement can only occur when submitting claim through part B
  • Covers physician and nonphysical provider services, outpatient hospital services, home health care not covered by part A (PT/OT) and other services such as diagnostic testing, durable medical equipment and ambulance costs
  • Enrollment in part B is voluntary to those receiving Part A
  • Payment into system via monthly premiums that are established yearly based on system expenses through deductibles & coinsurance programs

Advanced Practice Nurse Roles - ANSWER- 1. Nurse Practitioner

  1. Clinical Nurse Specialist
  2. Certified Registered Nurse Anesthetist
  3. Certified Nurse Midwife Nurse Practition - ANSWER- - provide care through diagnosis and treatment as well as addressing disease prevention and health management
  • 1893 Lillian Wald & Henry Street Settlement (HSS) House
  • HHS nurses obtained standing orders for emergency medications and treatments
  • nurses considered "good enough" to care for the poor whereas physicians seen as only careing for those who could pay
  • FNS/FSA nurse practice centered around the practice autonomy in the requirement that the patients be poor, marginalized and have little access to physician provided medical care
  • NP role formally described in 1960s and was implemented in outpatient pediatric clinics in response to a shortage of primary care physicians
  • Loretta Ford in 1965 established first Pediatric NP program (PNP) & was designed to prepare professional nurses to provide comprehensive well-child care and manage common childhood health problems
  • 1970 continue to enhance visibility in health system, and expand role while demonstrating cost effective quality care
  • role expanded/included because nurse role was essential to providing equal access to health care for all Americans
  • conflict surrounds role between other RN and NP and NP and physicians
  • issues surrounding prescriptive treatment & idaho in 1971 was first state to recognize diagnosis and treatment as part of practice
  • Support DNP but does not require educational programs to be at the doctoral level Clinical Nurse Specialist - ANSWER- - evolved out of increasingly complexity of nursing care
  • roots in psychiatric nursing
  • psych specialists date back to 1880 & richards is credited with founding specialty of psych nursing specialists
  • Rutgers University first educational program for CNS but was for psychiatric nursing
  • coronary care nurse specialists established in 1962 & CCU nurses blurred invisible boundary separating nursing and medicine
  • 1960s noted to be when clincal nurse specialist took on modern day form
  • three social forces drove specialization 1. increase in specialty related information 2. new tech advances 3. response to public need and interests
  • crtical care and oncology specialty grew in 1970s
  • ANA recognized CNS role 1970s defining the CNS as an expert practitioner and change agent
  • master degree required
  • role has postive effect on improving nursing care and patient outcomes
  • view shift from direct patient care to education and organizations (seen as too valuable)

Role Acquisition - ANSWER- - Anticipatory socialization to APRN roles that occurs in graduate education

  • role rehersal
  • development of clinical knowledge and skills
  • creation of supportive network Medicare part A Billing - ANSWER- - Covers hospital expenses
  • Does NOT reimburs the ARPN directly because those services are already paid for as part of the hospital expense
  • Includes inpatient care recieved in hospital or skilled nursing facility
  • Covers critical access hospitals, short-term care in skilled nursing facility, post institutional home health care and hospice care
  • funded through payroll taxes & beneficiary cost sharing (deductibles and coinsurance) ICD- 10 - CM codes - ANSWER- - Documentation for billing a service
  • APRN use
  • Diagnosis for which services are provided is what these codes represent
  • forms basis as to why a service is being provided
  • this is the most current version (international classification of diseases 10th revision)
  • longer the code the more specific the information is about the diagnosis
  • Basis for why a service is provided & lists 69,000 ways a human body has disease, sign, symptoms, ect
  • All categories are 3 Characters
  • Subcategories are 4 or 5 characters
  • Codes can be 3, 4, 5, 6, 7 characters
  • Codes may start with a letter to signify disease followed by numbers that signify etiology, anatomic site and severity
  • ex: S32.01A is code for wedge compression fracture of first lumbar vertebra and initial encounrter for closed fracture Six sections for CPT codes - ANSWER- - Actual service being provided
  • also documentation for billings services
  • specific services performed in relation to diagnosis
  • medical code, 5 digit number used to indicate level of service
  • six sections of codes: 1. evaluation and management 2. anesthesia 3. surgery 4. radiology 5. pathology and laboratory 6. medicine CPT codes by the APRN for initial hospital visits - ANSWER- 99221 - 99223
  • Evaluation and Management (E/M) codes
  • must consider history, physical exmainiation, and medical decision making when deciding on what E/M code to use
  • Common CPT codes for outpatient: New patient CPT codes 99201-99205 and establlished patient cpt codes 99211- 99215
  • Common CPT codes for inpatient: Initial hospital visit CPT code 99221-99223, subsequent hospital visit CPT code 99231-99233 and critical care CPT code 99291- 99292

Intrapreneurship Acticities - ANSWER- - when leaders use the enterpreneurial skills of innovation and risk taking and assume responsibility for achieving specific targets in an organization they are entrepreneurship

  • generally an employee in an exisiting health care system in which many of the indirect processes of the care delivery system may be controlled and managed by other Employees or departments
  • function within an institutional health care system aka microcosm of larger arena
  • risk taker
  • improves, redesigns or augments an employers current direct care process with a lesser role in day to day business administrative functions
  • dicrect clinical practice, guidance and coaching, leadership, and consultation
  • development of nurse triage and telemedicine services
  • transition care
  • development of interdisciplicary care teams
  • CRNA managed anesthesia provider services
  • Nurse triage problems
  • use of informatics to develop and implement new models of care delivery
  • development of nursing care policies Core foundation of all APRN education curricula - ANSWER- 1. Pathophysiology
  1. Health and physical assessment
  2. Pharmacology Entrepreneurship Activities - ANSWER- - plans, organizes, finances, operatres and participates in new health care delivery organization
  • control over and responsibility for
  • function within the context of the larger, societal health care system
  • risk taker
  • leaders go outside of traditional employment systems to create new opportunities to exercise their unique abilities
  • direct clinical practice, guidance and coaching, leadership, and consultation
  • nurse owned primary care clinics, specialty ambulatory practice, birth center
  • interdisciplinary health care business ventures
  • APRN owned health care practices
  • development of new models of reimburstment for nursing care delivery
  • wound care
  • health navigation
  • chronic disease management
  • APRN staffing businesses
  • Nurse midwifery consultants TIGER competencies for APN role - ANSWER- - bring together nursing stokeholds to develop a shared vision, strategies, and specific actions for improving nusing practice, education, and delivery of patient care through HIT (health information technology)

Health Professional Shortage - ANSWER- - HSPA is an area in which there are more than 3500 individuals for every primary care physician

  • does not include availability of NPs or PAs
  • responsible for designating areas to be medically underserved areas and medically underserved populations
  • federal government established critera to desginate health professional shortage areas (HPSA)
  • use these designations to provide additional resources
  • lack of data on NPs is barrier to accuratly assess and plan for workforce needs
  • questions about validity of using general measures such provider to population ratio Need for DNP - ANSWER- - prepared to sythesize exisiting research findings essential for EBP, to use data from sophisticated databases linked to EMR systems and national databases, and to participate in the formation of policies and procedures on facility wide or health system wide basis
  • original research
  • clinical consultant
  • design and participate in quality improvement projects
  • form strategic and productive alliances 2005 Donabedian Model - ANSWER- - usede to evaluate quality of APRN care
  • Three quality dimensions 1. structure 2. process 3. outcomes
  • structure is care delivery context and factors that dictate how providers and patients behave (setting in which care occurs)
  • process is action taken in the delivery of health care (what is actually done in giving and receiving care)
  • outcome is the effect of health care on patients and populations (effects of care on the health status of patients and populations)
  • model is core of all other outcome measurments and role impact models
  • variables can be studied independently or as a model for overall APRN practice
  • Nursing role effectiveness model is based on this concept APRN Practice Model - ANSWER- - Consensus model?
  • Hamric Integrative Model of Advanced Practice Nursing
  • conceptual definition of APN and define characteristics that include primary critera (graduate education, certification in specialty, focus on Clinical practice with patients) and a set of core competencies (direct clinical practice, collaboration, guidance and coaching, evidence based practice, ethical decision making, consultation, and leadership)
  • key components: primary critera, seven advanced competencies with direct care as the core, and environmental and contextual factors that must be managed for APN to florish
  • generic features of APN: 1. use of knowledge in practice 2. critical thinking and analytic skills 3. clinical judgement and decision making 4. professional leadership and clinical inquiry 5. coaching and mentoring 6. research skills 7. changing practice
  • three sphere of influence aka literature review on CNS practice to further support Hamric theory
  • first sphere (management of complex or vulnerable populations) three Characteristics of expert direct care, coordination of care and collaboration identified as essential & Second sphere: (educationing and supporting interdisciplinary staff) education, consultation and collaboration are important &third sphere (influence) facilitating innovation and change US Health System - ANSWER- - information rich enviroment
  • health encounters occur for the exchange of information
  • in constant state of evolution
  • US does not provide universal coverage
  • Medicare
  • Medicaid
  • ACA
  • healthcare law goes through congress
  • Department of Health and Human Services (HHS) responsible for public health
  • Licensure, accreditation, certification, education occur through system Florence Nightengale - ANSWER- - founder/mother of modern nursing
  • promote policy change to improve quality, dignity and equity for Crimean War
  • importance of using evidence to inform policy
  • work demonstrated how health policy faces challenges and opportunities in both big "P" and small "p" policies Policy - ANSWER- - law, regulation, procedure, administrative action, incentive, or voluntary practice of government and other institutions
  • health policy is authoritative decisions pertaining to health or healthcare made in all branches of government that are intended to direct or influence the actions, behaviors, or decisions of citizens Benner's Seven Domains of Expert Nursing Practice - ANSWER- - from novice to expert
  • based on expert practice of clinical nurses
  • domains are a combination of roles, functions, and competencies
  • domains not completely differentiated so there is overlap
  • domains: 1. helping role 2. administering and monitoring therapeutic interventions and regiments 3. effective management of rapidly changing situations 4. diagnostic and monitoring function 5. teaching and coaching funtion 6. monitoring and ensuring quality of health care practices 7. organizational and work role copetencies
  • is a conceptual model of practice Models of Conceptual Practice - ANSWER- - set of relatively abstrat and general concepts that address the central insterest to a discipline, the propositions that broadly describe these concepts, and the propositions that state relatively abstract and general relations between two or more concepts

Leadership models - ANSWER- - most are based on leaders having ability to understand themselves

  • selfwareness model (goleman) four skills that lead to improve leadership effectiveness
  1. self awareness 2. self management 3. social awareness 4. relationship management
  • transformational model(convey) is the seven habits of highly effective people/8th habit
  1. be practice, take initiative, choose your response 2. begin with the end in mind, define success 3. put first thing fitst, personally manage yourself 4. think win-win with a willingness to cooperate 5. seek first to understand and then to be understoon 6. synergies the whole is greater than the sum of its parts 7. sharpent the saw and renew your physical, mental, spiritual, and social dimensions 8. find your voice and inspire others to find theirs
  • model that addresses system change and innovation (Henry) focus on individuals are free to act in interconnected but not predicatable ways and one persons actions lead to changed in the context for others Collabortation - ANSWER- - true partnership in which there is a valuing of expertise, power, and respect for all members
  • recognize and respect all participants sphere of activity and responsibility
  • dynamic and interpersonal process Triple Aim Initiative (IHI) - ANSWER- - improving the patient experience of care
  • imporving the health of populations
  • reduce or control the per capita costs of care
  • (improving the patient expierence, reducing the cost of care, improving the health of populations) Consensus Model - ANSWER- - APRN regulation licensure, accreditation, certification & education
  • important definitions of roles, titles, and population foci & is based on APRN joing dialogue group
  • limitations with leacing competency requirments to each role & does not conclude education prep for specialization (debate over DNP vs experience)
  • Four recognized APRN roles: 1. Nurse Anesthetist 2. Nurse-Midwife 3. Clinical Nurse Specialist 4. Nurse Practitioner Primary or Acute Care
  • Six recognized population foci: 1. Family.individual across lifespan 2. adult gerontology
  1. gender specific 4. neonatal 5. pediatrics 6. psychiatrics/mental health
  • licensure occurs at levels of role and population foci
  • specialities focus on practie beyond role and population foci linked to healthcare needs (ex: oncology, orthopedics, critical care, pallative care)
  • APRN MUST complete accredited graduate level program in one of the four roles with a population focus, pass national certification exam, possess advanced clinical knowledge and skills, build on competencies of RN by demonstrating greater depth of knowledge by performing more complex skills, be perpared to assume responsibility, have significant expierence to reflect license, and obtain a valid license to practice
  • direct patient care is vital to APRN role
  • graduate course needs pharmacology, health and physical assessment and pathophysicology courses
  • licensure based on LACE
  • created to implement one national regulatory scheme that allows APRNs to be innovative and meet patient needs Coaching - ANSWER- - partner with client in a thought provoking and creative process that inspires them to maximize their personal and professional potential
  • coach: discovers, clarifys, and aligns with what client wants to achieve, encourages client self discovery, elicit client generated solutions and strategies and hold client responsible and accountable
  • based on a relationship in which individual identifies his or her goals Health Information Exchanges (HIE) - ANSWER- - potential to create widespread data sharing across healthcare continuum and can change how providers practice and evaluate outcomes
  • activity of secure health data exchange between two or more authorized parties
  • implies a standardized file format regardless of technology vendor
  • potential to make clinical information immediaely available
  • allows APRNs to extend access to care so triple aim can be achieved
  • successful implementation ex: Chesapeake Regional Information System for Our Patients (CRISP) in maryland and district of columbia Indirect Care - ANSWER- - consulting with other healthcare professionals
  • discharge planning
  • care coordination
  • education of bedside nurses
  • unit rounds
  • researching evidence based care guidelines
  • support staff supervision
  • billing and coding
  • compliance monitoring Direct Care - ANSWER- - use of holistic perspective
  • formation fo therapeutic partnerships with patients
  • expert clinical performance
  • use of reflective practice
  • use of evidece as a guide to practice
  • use of diverse approaches to health and illness management Pyramid of Evidence - ANSWER- - evaluates remaining evidence within EBP process
  • Base (in vitro/vivo): findings so not yield evidence efficacy, safety or a predictive value (DO NOT USE)
  • Second (Case/multiple case studies): results from these can be used as evidence that an intervention is feasible and can be applied safely but furthur investigtion is needed
  • four major types: 1. Client centered case consultation (traditional, generalist asks a specialist for expert opinion on particular case) 2. Consultee centered case consultation (focused on consultee difficulty in handeling the situation and goal is education for consultee and focus on task and knowledge development & is still about improve patient care) 3. Program centered administrative consultation (focus on work problem that requires planning and administration and expert opinion to provide care & goal is to provide expert consultation around a program administrative question) 4. Consultee centered adminstrative consultation (focus on consultee difficulty with programming/organizational objectives rather than particular patient & goal is to help consultee develop and implement adaptic behaviors to work within administrative boundaries)