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Biomedical subjects

C Buppert

Publications and source records attributed to C Buppert.

10 recordsLinked to original sources
PubMed2001

Avoiding Medicare fraud. Part 1.

In 1997, Congress authorized payments to nurse practitioners (NPs) for Medicare-provided services. NP services are now reimbursed at 85% of the physician fee schedule. As this source of reimbursement was realized, so was a new area of liability for NPs. Failure to follow billing rules can result in payment denial, repayment of fees already paid, mandated educational activities, fines, fraud prosecution, loss of Medicare-billing ability, and loss of employment. Appropriate billing entails adhering to guidelines for selecting procedure codes and proper medical documentation. This article identifies high-risk areas for NPs who bill Medicare and provides resources for accessing additional information.

Forms and Records Control↗
PubMed2001

Avoiding Medicare fraud. Part 2.

In 1997, Congress authorized payments to nurse practitioners (NPs) for Medicare-provided services. NP services are now reimbursed at 85% of the physician fee schedule. As this source of reimbursement was realized, so was a new area of liability for NPs. Failure to follow billing rules can result in payment denial, repayment of fees already paid, mandated educational activities, fines, fraud prosecution, loss of Medicare-billing ability, and loss of employment. Appropriate billing entails adhering to guidelines for selecting procedure codes and proper medical documentation. This article identifies high-risk areas for NPs who bill Medicare and provides resources for accessing additional information.

Documentation↗
PubMed2000

Measuring outcomes in primary care practice.

Systematic attention to outcomes is becoming a requirement of primary care practice. Outcomes of interest include improvement in health (medical outcomes), patient satisfaction with the health care experience (service outcomes), and curtailing of expenditures (cost outcomes). Primary care providers who monitor outcomes in their practice have many advantages: They have the opportunity to evaluate themselves before others evaluate them; they may alter or improve their system of care; and they can provide data on their effectiveness. This article discusses how primary care providers can measure outcomes at the practice level and the inherent values in this practice.

Humans↗
PubMed1999

HEDIS for the primary care provider: getting an "A" on the managed care report card.

In 1999, quality in primary care will be measured more closely than ever before. Quality will not only be measured--but also reported-- and reported in a form that consumers can use to compare health plans. A health plan's accreditation will depend on its performance on a series of 14 performance measures, referred to as the Health Plan Employer Data and Information Set, Version 3.0 (HEDIS 3.0), which the National Committee for Quality Assurance, an organization that accredits health plans, has developed, quantified, refined, and publicized. This article introduces the primary care clinician to HEDIS quality measures and recommends tools clinicians can use to score well in performance evaluations.

Health Benefit Plans, Employee↗
PubMed1998

Reimbursement for nurse practitioner services.

Whether a nurse practitioner (NP) is employed by a medical practice or is self-employed, the reimbursement policies of third-party payers will determine whether an NP continues to provide care on a long-term basis. The payers--Medicare, Medicaid, indemnity insurers, and managed care organizations--each have their own reimbursement policies and fee schedules, and each operates under a separate body of law. Some payers have a history of reimbursing for NP services in the same manner as they reimburse for physician services. On the other hand, some payers have recently begun to reimburse NPs directly, either as separate and apart from an employment relationship with a physician practice or following NP-specific rules and policies regarding reimbursement. This article offers basic information necessary to communicate with practice managers, billing experts, and the payers about reimbursement mechanisms and problems. It covers how to set up provider relationships with the various payers, how to submit bills, and how to deal with denial of reimbursement when it occurs.

Forms and Records Control↗
PubMed1997

Employment agreements: clauses that can change an NP's life.

An employment agreement is a legal contract that spells out the conditions of a working relationship between an employer and employee. Nurse practitioners (NPs) are being offered employment agreements. These documents are complex, lengthy, and require careful analysis. Three clauses commonly found in employment agreements are especially difficult to interpret and can have profound effects on an NP's life. These clauses are restrictive covenants, bonus formulas, and termination clauses. Restrictive covenants require an NP to promise-up front-not to compete with an employer when the present employment ends. Bonus formulas specify conditions under which an employer rewards an NP for superior performance. Termination clauses specify that an employer may end the agreement, without cause, with 30 days' notice. This article gives examples of each type of clause and advises NPs about how to negotiate reasonable terms.

Contract Services↗
PubMed1996

Nurse practitioner private practice: three legal pitfalls to avoid.

Private practice is now a viable option for nurse practitioners. NPs who open their own practice will be wise if they anticipate, consider, and act to prevent certain potential legal problems. Awareness and avoidance of these problems--risk avoidance--is the legal equivalent of preventive medicine. This article gives NPs an attorney's perspective on setting up a practice and some of the legal pitfalls to avoid.

Humans↗