Reimbursement Concepts PDF

Reimbursement Concepts Nancy Munro RN, MN, ACNP-BC, FAANP Objectives ► At the end of this presentation, we will: * Give you an overview of reimbursement system * Review basic components to proper billing * Review critical care billing basics Introduction History of Reimbursement ► Phys...

Reimbursement Concepts Nancy Munro RN, MN, ACNP-BC, FAANP Objectives ► At the end of this presentation, we will: * Give you an overview of reimbursement system * Review basic components to proper billing * Review critical care billing basics Introduction History of Reimbursement ► Physician fee for service model ► Rural Health Care Protection Act of 1997 ► Balanced Budget Act of 1997 allowed NPs and CNSs to bill for their services at 85% of physician fee schedule ► Reimbursement of CNM and CRNA services was initiated in the 1980s, and they are able to bill at 100% depending on the clinical situation The person who does the work… And documents the work… Bills for the work!!!  Who is watching? Insurance Companies Centers for Medicare and Medicaid (CMS) Uncle Sam Organizations Monitoring Documentation State NP Organizations State NP State Boards of Nursing Organizations Other payers National NP State Carriers Organizations Scope of Practice ► Board of Nursing: Legal authorization ► National: Professional organizations * AANP and AACN ► Area of certification * Adult gerontology acute care nurse practitioner (AG-ACNP) vs Primary care * Adult vs. Pediatric acute care APRN Regulatory Model https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf Why is Coding/Billing Important? ► History behind coding and billing ► Implications * Legal * Strategic * Economic ► Make sure your documentation always supports your coding Reimbursement Structure CMS MACs https://www.cms.gov/files/document/ab-jurisdiction-map03282023pdf.pdf Who Can Bill? ► Must have provider number from Medicare * Centers for Medicare/Medicaid Services (CMS) website ► Can obtain Medicaid number following state process ► Employment status: Discuss with your institution * Who employs you * How you are listed; cannot be listed on cost report or Part A Challenge for NPs/PAs/CNS 85% vs 100% Medicare Part A ► Part A includes inpatient care received in a hospital or skilled nursing facility ► Critical access hospitals, short-term care in skilled nursing facilities, post-institutional home health care, and hospice care. Those individuals eligible for Social Security are automatically enrolled in Part A. Medicare Part B ► Part B includes coverage of physician services and outpatient care ► Physician and non physician provider services, outpatient hospital services, home health care not covered by Part A such as physical and occupational therapy, and other medical services, such as diagnostic testing, durable medical equipment, and ambulance costs. Enrollment in Part B is voluntary to beneficiaries receiving Part A. CMS Website National Provider Identifier (NPI) ► Purpose is to assign a unique national identifier number to every provider of Medicare health care services ► Will eventually eliminate the need for multiple provider numbers and even DEA numbers ► Change in system finalized in 2008 ► Website: https://nppes.cms.hhs.gov National Provider Identifier If you are interested in billing ► You should * Talk with the physician(s) you work with and your hospital administrator * Educate yourself and develop a plan * Look for state resources; “experts” * Develop a relationship with “payor”  Section 2 Reimbursement Terminology Terminology Review ► ICD-10 codes: International classification of diseases established by the WHO; updated at intervals ► CPT: Current procedural terminology established by the AMA; updated yearly (5 digits) ► RBRVS: Resource based relative value scale is scoring system for payment; R VU is relative value unit ► E/M: Evaluation and management ICD-10 Codes ► ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) consists of two parts: ► ICD-10-CM for diagnosis coding in all health care settings ► ICD-10-PCS for inpatient procedure coding in inpatient hospital setting only ► http://www.cdc.gov/nchs/icd/icd10cm.htm#10update ICD-10 Codes ► Toxic effect of venomous animals(T63.0) Snake venom ► (T63.1) Venom of other reptiles ► (T63.2) Venom of scorpion ► (T63.3) Venom of spider ► (T63.4) Venom of other arthropods ► (T63.5) Toxic effect of contact with fish ► (T63.6) Toxic effect of contact with other marine animals ► (T63.8) Toxic effect of contact with other venomous animals ► (T63.9) Toxic effect of contact with unspecified venomous animal ICD-10-CM Structure - Format CMS Road to 10:http://www.roadto 10.org What are CPT’s? ► Current Procedural Terminology ► Represents the medical and surgical services rendered ► Updated yearly ► RBRVS (Resource Based Relative Value Scale) began in January of 1992 ► RVUs were designed to reflect the “amount of work” per visit/procedure based on RVUs Terminology Review ► RBRVS: Resource Based Relative Value Scale Affects method of reimbursement Used to establish fees and project income Scaling system; RVU is relative value unit o Work o Practice expense o Malpractice Geographical practice cost indices (GPCI) Geographical adjustment factor (GAF) RBRVS Example: CPT 99213 ► Generic 1.39 RVUs x $36.079 = $50.14 ► New Jersey (2014) 1.5209 RVUs x $36.079 = $54.87 CPT Origin ►Resource-Based Relative Value Scale developed in 1989 ►CMS needed guidance when developing and revising CPTs ►AMA/Specialty Society Relative Value Scale Update Committee (RUC) ►CPT Editorial Committee Laugesen 2014 Who is Responsible? ► E/M or visit based codes should be assigned by the physician or non-physician provider ► The billing provider is ultimately responsible for all codes submitted for payment ► Coding should be a team effort between registration staff, physicians, nurses and coding/billing staff ► Inaccurate coding can result in any of the following: * Reduced revenues * Lost charges on procedures * Risk of audit or review * Incomplete/inaccurate physician profile * Possible fraud charges Evaluation and Management Categories ► Office or Other Outpatient Visits (New & Established) ► Preventative Medicine Visits ► Consultations: Office or Other Outpatient, Inpatient ► Hospital Observation Services ► Hospital Inpatient Care (Initial and Subsequent) ► Emergency Department Services ► Critical Care Services ► Neonatal Intensive Care ► Nursing Facility Services ► Domiciliary, Rest Home or Custodial Services ► Home Services Basic Principles of Documentation ► Medical record should be complete, legible, dated and signed with credentials ► Each patient encounter should include - S.O.A.P. ► Should not use rule out or possible wording ► The rationale for all tests ordered should be documented or easily inferred ► Past and present diagnosis should be readily available ► Appropriate health risk factors should be identified ► Patient progress, response to treatment and revision in plan should be documented ► ICD-10 codes should justify the provided services by verifying the problem that required it  You can’t bill for w hat you do -- you can only bill for w hat you docum ent!! Medicare Claims Processing Manual http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf CMS Documentation Guidelines ► Documentation Guidelines for Evaluation & Management Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning- Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide- ICN006764.pdf ► 1995 or 1997 Determining the Level of Coding ► The Key Elements: * History * Examination * Medical Decision Making ► Contributory Elements: * Counseling * Coordination of care * Nature of problem ► The Non-Key Elements: * Time except in critical care, counseling Selection of E&M Service * Identify category & subcategory * Review reporting instructions for category * Review level of E/M service descriptors Level 1-5 * Determine extent of history * Determine extent of physical exam * Determine complexity of medical decision making * Select appropriate level of E/M service Physician Fee Schedule (PFS) Changes 2022 ► https://www.cms.gov/newsroom/fact-sheets/calendar- year-cy-2022-medicare-physician-fee-schedule-final-rule 2022 PFS Changes with Evaluation and Management Rules ► Hospital inpatient and outpatient services ► Critical Care Services Skilled Nursing Facility and Nursing Facility Services  Section 3 Documentation Rules The Three Key Components ► History ► Examination ► Medical Decision Making (MDM) “Score Card” ► Score card is developed and used by payor based on rules developed by CMS ► Payor reviews your documentation and scores your notes based on components present ► Main components are: * History * Examination * Medical decision making Subsequent Hospital Visit Codes ► 99231 ► 99232 ► 99233 Score Card How You Are Going to Document ► Decision made on your “visit” * Clinic visit * New consult * Critical care visit ► Discussion to have with whoever you are practicing with ► Always keep your intent for your visit in mind when you are documenting ► Visit will be scored depending on level of complexity History Choosing a CPT Code ► Problem focused ► Expanded problem focused ► Detailed ► Comprehensive Chief Complaint ► As defined: “A concise statement describing the symptom, problem, condition, diagnosis or other factor that is the reason for the encounter, usually stated in the patient’s words” ► MUST be documented on all inpatient and outpatient visits for all levels of service ► Can be written by ancillary staff - note must be attached to the record signed by the physician. If separate, the physician should refer to the ancillary note/vitals sheet in his documentation ► “Follow-up”: must indicate condition for which patient was originally treated (i.e., “follow-up for diabetes management”) History ► There are three parts to History: * History of Present Illness * Past, Family and Social History * Review of Systems  History of Present Illness ► Chronological description of development of present illness from first symptom or previous visit to present ► 8 Elements: Brief Extended 1 - 3 elements 4 or more elements * Location - where is symptom or pain (pain is in LLQ) * Quality - character of the symptom or pain (pain is sharp) * Severity - a rank of the symptom or pain (pain is 7/10) * Duration - describes how long the symptom or pain has been present or how long it lasts when the patient has it (pain started 3 days ago) * Timing - describes when the pain or symptom occurs (increases after eating) * Context - is the situation associated with the symptom (after heavy, greasy meal) * Modifying Factors - things done to make the symptom or pain better or worse (tried antacid without relief) * Associated Signs/Symptoms - describe other symptoms or pains that occur in conjunction with the presenting condition or illness (Also nauseated) Review of Systems ► Inventory of body systems * Series of questions to identify signs and/or symptoms patient is experiencing * If 2 or more documented and “all others reviewed are negative” = Complete * 14 systems recognized Problem Pertinent Extended Complete 1 system 2 - 9 systems 10+ systems Past, Family and Social History ► Consists of 3 areas: * Past History: Illnesses, operations, injuries, current meds * Family History: Includes hereditary, risk factors *Social History: tobacco, alcohol, living arrangements, marital status, occupation, education Complete Complete Pertinent 1 - 2 areas for: All 3 areas for: 1 of the 3 areas Estab. pt visits New pt. visits for all types ED Observation Subsq. NF Initial hospital care of service Initial consults History Documentation ► Portions may be recorded by ancillary staff or patient (ROS and PFSH) ► Standardized history forms and patient questionnaires * “history form reviewed with patient, see form for details” is all that is necessary to cover the ROS and PFSH portions. ► For inpatients, on subsequent visits, you can refer to initial H&P note. Examination 1995 Exam Guidelines 10 Body Areas 12 Organ Systems 1. Eyes 1. Head including the face 2. Ears, nose, mouth, throat 2. Neck 3. Cardiovascular 3. Chest including breast and axilla 4. Respiratory 4. Abdomen 5. Gastrointestinal 5. Genitalia, groin, buttocks 6. Genitourinary 6. Back, including the spine 7. Musculoskeletal 7 - 10. Each extremity 8. Skin 9. Neurologic 10. Psychiatric 11. Hematologic/Lymphatic /Immunology 12. Constitutional ( e.g., vital signs, general appearance) 1995 Exam Guidelines Problem Expanded PF Detailed Comprehensive Focused 1 body area or 2 to 7 body 2 to 7 body areas/ 8 or more organ organ system areas/ organ systems systems or organ systems with one complete single system described specialty exam in detail Exam Documentation ► “All nl” is not sufficient documentation for an all-system examination ► “Abnormal” is not sufficient for a body area or system - must describe abnormality ► Specific (+’s), or (-’s) of effected systems should be noted in detail ► A line drawn through a listing of body systems is NOT sufficient - each area examined must have pertinent documentation ► When stamps are used, if an area is left blank it is not considered reviewed. You must document the pertinent finding. ► Use of symbols like the null sign or arrows are not considered acceptable without further description Medical Decision Making ► There are three parts to MDM * Number of diagnosis or management options * Amount and/or complexity of data to be reviewed * Risk of complications and/or morbidity or mortality Number of Diagnoses & Treatment Options IMPORTANT TO Self Limited Minor 1 point each (Max = 2 problems) DOCUMENT: Estab. Prob. Stable 1 point each Is the problem stable or Estab. Prob. Worsening 2 points each worsening? New Prob – No work 3 points each (Max = 1 problem) Is this a new problem to the up examiner? New Prob – Work up 4 points each Is there additional work-up planned to determine Minimal (1 point) the diagnosis? Limited (2 points) Multiple (3 points) Extensive (4+ points)  Complexity of Data Complexity of Data Chart Minimal (1 point) Lab Tests 1 point Limited (2 points) Radiology tests 1 point Multiple (3 points) Other Medicine Tests 1 point Extensive (4+ points) Discuss tests w/performing Dr. 1 point IMPORTANT TO DOCUMENT: Tests ordered or reported reviewed Independent review of image, tracing, 2 points (labs, x-rays, etc.) spec. Personal interpretations of Decision to order old records from Dr. 1 point tests (personal review of test, not reports) Review & summarize old records 2 points Decision to order or review of old records  Risks of Complications, Morbidity, and Mortality Minimal Choose highest level selected from all three Low Presenting Minimal Low Moderate High Prob. (Cold) (2 or more (1+ Chronic) (Severe, Acute) Multiple stable) Extensive Diagnostic Minimal Low Moderate High Proc. (Lab, EKG) (PFT, (Stress Test) (proc. w/risk) Imaging) IMPORTANT TO DOCUMENT Mgmt. Minimal Low (OTC Moderate High Is it a chronic illnesses Options (rest, drugs, PT, (Rx mgmt) (Surg/Life (or progression or bandage) OT) threat) exacerbation of a chronic illness) Overall Risk Minimal Low Moderate High Treatment plans, including medications, procedures, IV therapy Yoga Cat Hospital Care (1995) Subsequent Hospital Care (2 of 3 components) - Interval Exam Medical Decision Making History (2/3) HPI ROS P/F/S # Dx Amt Data Risk 99231 1-3 1 area/systems 1-2 0-2 Low (15) 99232 1-3 1 2-7 (2-4) 3 3 Moderate (25) organ systems 99233 4+ 2-9 2-7 (5-7+) 4+ 4+ High (35) organ systems Shared Visits and “Incident-to” Concepts Shared Visits http://www.cms.hhs.gov/transmittals/downloads/R1776B3.pdf; http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf Shared Visit Requirements ► Service must be within scope of practice ► Same group practice ► Service may occur jointly or independently on same calendar day ► Total documentation by NP and physician should support level of service reported ► Physician provides face-to-face Bill either physician or NP N o face-to-face-- Bill ON LY under NP Do the Math! Shared Visit “Counter-argument” ► You work in a cardiology practice ► Average patient census for practice is 15 patients ► One cardiologist in hospital with 1 NP ► Cardiologist has 4 cardiac catheterizations in a day ► Average cost of cardiac catheterization ~$15,000 ► Cardiologist reimbursement ~ $1000 to $2000 ► Shared visit reimbursement at highest level: $85 ► 85% of $85 is $72; multiply by 15 ~ $1083  Shared Visit “Counter-argument” More importantly, NP can reduce hospital stay and decrease readmit rate by focusing on details of care 2022 PFS Changes ► The practitioner who performs the “substantive portion” of the service will be billing provider. ► Shared/Split Visits E/M levels based on Documentation - for the physician to be billing provider, they must document the entirety of one key element; either History, Examination, or Medical Decision Making. E/M levels based on Time - the provider with the greater amount of time is to be the billing provider ► The use of the FS m odifier (25) to identify a Shared/ Split service is required. SCCM Summary of PFS Changes Split (Shared) Services ► Split (shared) services are now allowed for new and existing patients. ► For 2022, split (shared) services for non-critical care encounters can be billed based on either completion of a key component or the practitioner who reports the greater amount of time. ► Split (shared) billing is allowed for critical care services. The bill may be submitted for individual practitioners based on time or the time may be submitted under the provider proving the substantive portion of the time. ► CMS will create a separate identifier for split (shared) services. ► For split (shared) services, the physician and APP must be in the same group, but CMS has not further defined “group.” SCCM Critical Connections 11/2021 How Do I Bill “Incident-to”? http://www.cms.hhs.gov/transmittals/downloads/R1764B3.pdf  “Incident-to” Services ►Commonly furnished physician’s office or clinic ►Furnished by physician or auxiliary personnel under physician’s supervision ►Commonly rendered without charge or included in MDs bill ►An integral, although incidental part of physician’s professional service http://www.cms.hhs.gov/transmittals/downloads/R1764B3.pdf  “Incident-to” ►Physician must perform “the initial service and subsequent services of a frequency which reflects his active participation in management of course of treatment” ►Provider under whose name/# the bill is submitted must be present in office suite when service is provided. Medicare Carriers Manual (Part 3, Chapter II, section 2050) “Incident-to” Summary For 100% reimbursement: ► MD to see patient on initial visit ► MD presence in office suite if APRN seeing pt in subsequent visits ► Some frequency of MD participation in plan of care ► If any of above criteria not met, billed 85% under NP NPI  “Incident-to” Update ► M edPAC Recom m ends Elim inating "I ncident-To" Billing for NPs  MedPAC is an advisory committee with significant influence on legislative and regulatory Medicare policy. ► October and December meetings, MedPAC discussed NP ► and PA billing with a focus on "incident-to" billing.  January 17, 2019 meeting, MedPAC commissioners voted in favor of two recommendations related to NP/PA billing. It is our understanding that these recommendations will be included in MedPAC’s March report on Medicare Payment Policy. https://www.mdedge.com/chestphysician/article/177219/practice - management/medpac-eyes-incident-billing “Incident-to” Update  Require NPs and PAs to bill Medicare directly and retire "incident-to" billing for NPs and PAs. MedPAC staff highlighted that "incident-to" billing obscures Medicare billing data and data on who is providing care, leads to inaccurate valuation of services and increases costs for beneficiaries within the Medicare program. MedPAC staff made clear that the recommendation in no way inhibits the scope of services that an NP is authorized to provide to Medicare patients.  Direct the Secretary of the U.S. Department of Health and Human Services (HHS) to refine the Medicare specialty designation for NPs and PAs. Medicare designates all NPs as specialty code "50", regardless of the type of care being provided by the NP. MedPAC staff again highlighted that this single specialty designation leads to inaccurate data on how many NPs are providing specialty care and how many NPs are providing primary care.  Section 4 Critical Care Coding and Regulatory Expectations Critical Care Billing ► There are two codes used: * 99291 First 30-74 minutes * 99292 Additional 30 minutes ► TIME DEPENDENT ► Must document * What you see * What you do * Time it took you to do it Critical Care Billing 2 There are three components, all of which must be documented, for the provision of critical care services: 1. “ Instability” of the patient (“what did you see”) 2. Complexity of Medical Decision Making (“what did you do”) 3. Time Components of CC Billing ► Clinical Criterion (w hat did you see) …impairs one or more vital organ systems such that there is a high probability of sudden clinically significant or life-threatening deterioration in the patient condition Components of CC Billing ► Treatm ent Criterion (w hat did you do) Critical care services require direct personal m anagem ent by the physician. They are high complexity decision making to assess , manipulate, and support vital system function(s) to treat …vital organ system failure and / or to prevent further life-threatening deterioration of the patient’s condition Note Template Cardiovascular: BP____/____ HR ____ PA ____/____ CVP ____ PCWP ____ CI ____ Epine _____ Norep _____ Dobt _____ Milrinone ____ Neck veins: □ Distended □ Nondistended Sternum: □ Stable □ Unstable Auscultation: □ S1S2 □ Other ____________ Mottling/Cyanosis: □ None □ Other Pulses: Carotid (R/L): __/__ Femoral (R/L): __/__ Popliteal (R/L): __/__ DP (R/L): __/__ PT (R/L): __/__ Rhythm: _________________ □ Rhythm strip personally reviewed ECG: ____________________ □ 12 lead ECG personally reviewed Hospital scene CMS Critical Care Reference https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2997CP.pdf SCCM Summary of PFS Changes Critical Care ► Follow-up care: When medically necessary, physicians or APPs in the same specialty and same group may provide follow-up care on the same calendar day. ► For follow-up care, if one practitioner does not meet the time reporting requirements for 99291, the time may be aggregated with other providers. ► Concurrent critical care: When medically necessary, critical care services can be furnished concurrently to the same patient on the same day by more than one practitioner representing more than one specialty. SCCM Critical Connections 11/2021 SCCM Summary of PFS Changes ► Critical care and E/M services: In limited circumstances, CMS will allow critical care and E/M services to be billed on the same day (critical care after other E/M services). ► Critical care unrelated to the procedure is allowed during the global surgical period. ► Critical care that is continuous and crosses midnight will be reported on the day the encounter started. SCCM Critical Connections 11/2021  Regulatory Expectations 80% Subsequent Hospital Visits Codes 20% Critical Care Codes CMS Transmittal 1548 (2008) ► However, if a physician or a qualified NPP provides “staff coverage” or “follow up” for each other after the first hour of critical care services was provided on the same calendar day by the previous group clinician (physician or qualified NPP), the subsequent visits provided by covering physician or qualified NPP in the group shall be billed using CPT critical care add on code 99292. The appropriate NPI number shall be reported on the claim” Denial Data Appeals Process http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/medicareappealsprocess.pdf  Section 5 Additional Codes and Coding Concepts Transitional Care Codes 99495 (face-to-face visit within 14 days) 99496 (face-to-face visit within 7 days) Transitional Care Management (TCM) ► 30-day time period starting on the inpatient discharge date ► Three components must be provided to the patient: * Interactive contact * Certain non-face-to-face services * Face-to-face visit ► http://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network- MLN/MLNProducts/Downloads/Transitional-Care- Management-Services-Fact-Sheet-ICN908628.pdf Transitional Care Code 99495 ► Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge ► Medical decision making of at least moderate complexity during the service period ► Face-to-face visit, within 14 calendar days of discharge Transitional Care Code 99496 ► Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge ► Medical decision making of high complexity during the service period ► Face-to-face visit, within 7 calendar days of discharge  Dying In America http://www.iom.edu/~/media/Files/Report%20Files/2014/EOL /Key%20Findings%20and%20Recommendations.pdf IOM Report “Dying in America” ► Improving Quality and Honoring Individual Preferences Near the End of Life ► Provide financial incentives for medical and social support services that decrease the need for emergency room and acute care services ► Coordination of care across settings and providers (from hospital to ambulatory settings as well as home and community) ► Improved shared decision making and advance care planning that reduces the utilization of unnecessary medical services and those not consistent with a patient’s goals for care Advanced Care Planning https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R216BP.pdf Advanced Care Planning ► 99497- first 30 min ► 99498 - each additional 30 * Explanation and discussion min of advanced directives * Explanation and discussion * Face to face of advanced directives * Face to face Advanced Care Planning ► Process that enables individuals to make plans about their future health care ► Advance care plans provide direction to healthcare professionals when a person is not in a position to either make and/or communicate their own healthcare choices ► Effective January 2016 CMS will pay for voluntary Advance Care Planning as either: * A separate Part B service when it is medically necessary * An optional element of a beneficiary’s Annual Wellness Visit (AWV) * No place-of-service limitations Telehealth Services EXPLODING!!! Telehealth Due to COVID-19, there are changes in original proposals ► Originating sites now modified ► Distant site practitioners no change ► Telehealth services, billing and payment * Addition of telehealth GQ modifier * Place of Service (POS) 02-Telehealth ► Telehealth originating sites billing and payment * Requires clear communication with your MAC Medicare Telehealth Services Telehealth Services Medicare Learning Network o https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf Chapter 12 Medicare Claims Processing Manual o https://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/clm104c12.pdf o Section 190 Recommendations ► Know your billing patterns ► Know your coding criteria ► Know your regional payor and their interpretations of CMS rules ► Know your compliance department ► Talk to your state nurse practitioner organization Cat Yoga 2  Contact me: [email protected] References Buppert, C. (2015). Nurse practitioners’ business practice and legal guide 5th ed. Burlington MA: Jones and Bartlett Learning Kleinpell, R. et al (2012). Integrating nurse practitioners and physician assistants into the ICU. Society for Critical Care Medicine Laugesen, M. J. (2014). The Resource-Based Relative Value Scale and Physician Reimbursement Policy. Chest 146(5): 1413-1419 Munro, N. (2013). What an Acute Care Nurse Practitioner Should Understand about Reimbursement. AACN Advanced Critical Care; 24:110- 113 Munro, N. (2013). What an Acute Care Nurse Practitioner Should Understand about Reimbursement: Critical Care Issues. AACN Advanced Critical Care; 24: 241-244 Munro, N., & Madgic, K. (2019). Hamric and Hanson's Advanced Practice Nursing, 6th Edition. Chapter on Reimbursement. Philadelphia: Saunders References Dorman, T., Britton, F., Brown, D., & Munro, N. (ed) (2014). Coding and Billing for Critical Care: A Practice Tool. Mount Prospect, Il: Society of Critical Care Medicine Centers for Medicare and Medicaid Services http://www.cms.hhs.gov www.cms.hhs.gov/providers/enrollment/forms/cms855r.pdf E/M documentation guidelines: www.hcfa.gov/medlearn/emdoc.htm