Download PROFESSIONALISM FINAL EXAM and more Exams Nursing in PDF only on Docsity!
PROFESSIONALISM FINAL EXAM
are malpractice lawsuits against NPs rare but can do financial and emotional harm? - yes how many years do you have to file a malpractice case? - 4 years does there have to be harm and deviation from standard of care for malpractice? - yes what are the most frequent malpractice that occurs in NPs? - failure to diagnose delayed diagnosis diagnostic related what are these examples of: o Lawsuits can be brought against wrong person, or claim can be unfounded o Suits may feature NP only because NP is part of medical practice being sued o Only lawsuits featuring a damage award are required to be reported to the National Practitioner Data Bank (NPDB) o Unsuccessful lawsuits filed against NPs are difficult to track? - things to consider with malpractice do you have to prove 4 points to have a malpractice case? - yes, you have to meet 3 of the 4 criteria what are the 4 points a plaintiff in a malpractice suit must prove? - NP owed plaintiff a duty NPs conduct fell below the standard of care NPs conduct caused the plaintiff injury plaintiff was injured
what are these examples of: § NP owed plaintiff a duty § NP's conduct fell below the standard of care § NP's conduct caused the plaintiff injury § Plaintiff was injured? - 4 points to have a malpractice case what are these examples of: duty causation of injury injury? - elements of malpractice what are the different elements of malpractice? - duty causation of injury injury what element of malpractice is relationship established, giving advice, and unclear roles? - duty what is the standard of care for NPs? - reasonable care equal to MD expert witness may testify what element of malpractice is when a breach of standard of care must have cause injury to the plaintiff and provider can be extremely negligent yet may not be the cause of injury? - causation of injury
surgery related monitoring related failure or delay in referral or consultation allegations what are the 3 different types of malpractice insurance? - claims made occurence insurance tail coverage what are these examples of: claims made occurance insurance tail coverage? - malpractice insurance what type of malpractice insurance policy is the NP covered only when the insurance policy is active and NPs should keep such insurance even after they retire or leave the profession to provide protection against suits for incidents in years past (tail)? - claims made what malpractice insurance covers any incident that occurs while the NP was insured? - occurance insurance what malpractice insurance is an extended reporting period endorsement offered by a NP's current malpractice insurance carrier, which allows an insured NP the option to extend coverage after the cancellation or termination of a claims made and it is not cheap? - tail coverage does credentialing and licensure for prescriptive authority occur at a state level? - yes
do most states require core advanced pharmacohtherapeutics course and yearly CE credits to maintain prescriptive privilege? - yes what may be included in state's licensure or recognition of APRNs or may be conferred as a separate license or authority? - prescriptive authority do APRNs need to understand the mechanism of legal prescriptive authority in their state and keep appropriate documentation of CE hours? - yes what are these examples of: o Graduation from approved APRN program o Licensure and APRN in good standing o National certification in APRN population focus area o Recent pharmacotherapeutics course of at least 3 credit hours (45 contact hours) o Evidence of collaborative practice agreement o Ongoing CE hours to maintain prescribing status o State prescribing number and national Drug Enforcement Administration (DEA) number? - requirements for APRN prescribers what are the requirements for APRN prescribers? - o Graduation from approved APRN program o Licensure and APRN in good standing o National certification in APRN population focus area o Recent pharmacotherapeutics course of at least 3 credit hours (45 contact hours) o Evidence of collaborative practice agreement o Ongoing CE hours to maintain prescribing status o State prescribing number and national Drug Enforcement Administration (DEA) number
what credentialing change requires that APRNs legally represent themselves as an APRN within one of the population focus and by their role (CRNA, CNM, CNP, CNS)? - titling what credentialing change meets criteria established by state board of nursing and be held to highest level of regulation and the state laws have two forms: statues defined by the nurse practice act and rules and regulations made by state agencies? - second licensure what type of credentialing has steps to seek hospital privileges? - institutional credentialing what type of credentialing is this: steps to seek hospital privileges § Ask a nurse administrator how credentialing committee is organized and who makes up membership; ask nurse colleagues for support § Obtain application package and college documents § Garner support from collaborating physicians § Determine specific privileges § Practice congruent with APRN education and national certification? - institutional credentialing what type of credentialing is the process the agency utilizes to determine if the provider is qualified to receive privileges to practice and method to ensure the provider is competent and meets the necessary requirements? - hospital credentialing what type of credentialing consists of: § Reimbursement dependent on credentialing with insurance companies § Council for Affordable Quality Healthcare (CAHQ) is the universal provider data source § Greater than 120 organizations are represented in the CAHQ
§ Free and must update every 120 days? - insurance credentialing when applying to a big healthcare center does credentialing come first? - yes what comes from the board of nursing from our state and varies state to state? - license do universities undergo accreditation? - yes what are the 3 different code sets that drive reimbursement? - CPT codes ICD-10 codes healthcare common procedure coding system (HCPCS) what are these examples of: CPT codes ICD-10 codes healthcare common procedure coding system (HCPCS)? - code sets that drive reimbursement what code sets that drive reimbursement have to do with actual care and are current procedural terminology? - CPT codes what code sets that drive reimbursement have approximately 7,800 available codes for reporting medical, surgical, and diagnostic services in outpatient and office settings, as well as acute care emergency settings, ambulatory surgery, and inpatient procedures done in some hospitals outside the United States and new codes are released each october? - CPT codes what codes are developed by American Medical Association? - CPT codes
what are commonly used CPT codes? - E & M codes outpatient codes initial hospital visit subsequent hospital visit critical care codes what are these examples of: E & M codes outpatient codes initial hospital visit subsequent hospital visit critical care codes? - commonly used CPT codes what are the 6 sections of CPT code manual? - · Evaluation and management (E & M) · Anesthesia · Surgery · Radiology · Pathology and laboratory · Medicine what are these examples of: · Evaluation and management (E & M) · Anesthesia
· Surgery · Radiology · Pathology and laboratory · Medicine? - 6 sections of CPT code manual what commonly used CPT codes are used for provider-patient encounters, are the building blocks of documentation for encounters, multiple codes can be used when billing encounters, codes are determined by the history, physical exam, and medical decision making, and are utilized for reimbursement? - E & M codes what codes are determined by the history, physical exam, and medical decision making? - E & M codes what commonly used CPT codes are for new and established patients? - outpatient codes what type of outpatient CPT code is for someone who has not received any professional services from physician or physician group practice in the last 3 years? - new patient what type of outpatient CPT code is for someone who is seen and followed within the last 3 years? - established patient what type of CPT code does documentation range from less complex to in depth and higher complexity changes codes and increases reimbursement rate? - initial hospital visit what type of CPT code is for patient progress and need for further diagnostics and treatment, documentation should reflect patients status and evolution of medical decision making, and documentation details must support the service provided? - subsequent hospital visits what CPT codes are 99291 and 99292 used for? - critical care codes
in hospital prescriptions do you need or not need to have a DEA number? - do not need to have a DEA number what identifier number are we required to get, it is the standard identifier for health care providers, it is how insurance companies ID us, it is free and you must apply, and this number identifies you as you and no matter what insurance company you bill for or hospital bills for of if you do a procedure, all insurances will recognize your distinct NPI number to then reimburse? - NPI number did HIPAA mandate the use of standard identifier for health care providers? - yes what identifier is assigned by national plan and provider enumeration system (NPPES)? - NPI number is obtaining an NPI number mandatory and needed to practice and bill properly? - yes what is a unique number that is required method to recognize providers, it functions like a social security number, and when you apply you need your social security number, DOB, address, phone, place of practice, and if not practicing you may use your home address? - NPI number what is for: o For individuals, families, and children with limited income and resources o It is based on income and lower income of patients of all ages can apply o It is managed by states and federal government o Helps older adults and people with disabilities with the rising cost of nursing facility care and other health care expenses medicare or medicaid? - medicaid
what is generally for people who are 65 and older or who have a qualifying disability, it is managed by the federal governments not by the states, and people over the age of 65 automatically qualify for medicare regardless of their income? - medicare what is managed by the states and federal government, medicare or medicaid? - medicaid what is managed by the federal government, not the states, medicare or medicaid? - medicare what do patients younger than 65, but are considered having a disability, already are identified having a medical disability, are unable to work, or patient that are on dialysis and on ESKD automatically qualify for? - medicare do you have to take medicare? - yes, even if you are super wealthy and do not need it, you have to sign off saying you do not want it what will reimburse first medicare or medicaid? - medicare and then medicaid will pick up the amount not covered by medicare if patients have both what are the 4 parts of medicare (medicare reimbursement)? - A B C D what part of medicare (medicare reimbursement) is inpatient hospital coverage, you get this when you turn 65, it is elective for others, it is what pays out and reimburses for inpatient stays/hospital stays, and also covers skilled nursing facility, home health, and hospice care? - part A
what are these examples of: resource based relative value scale the childrens health insurance program (CHIP) medicare access and CHIP reauthorization act of 2015? - medicare reimbursement is the goal of the APRN reimbursement to bill insurer directly for services? - yes are APRNs only reimbursed at 85% of the physician fee even though costs and care are the same? - yes what are jointly performed same day between APRN and physician, must have face to face physician encounter, documentation by physician linked to APRN note, and physician note must include 1 of 3 components of evaluation and management? - shared visits what is this an example of: § Physician sees new patients or established patient with new problem § Physician must be physically available within suite of service § Physician performs services at frequency that reflects active participation in management of treatment? - when the APRN bills 100% when does the APRN bill 100%? - § Physician sees new patients or established patient with new problem § Physician must be physically available within suite of service § Physician performs services at frequency that reflects active participation in management of treatment what means "incident to services of physician"? - "incident to"
are new CPT codes added to address need for better understanding and discussion of end of life care? - yes what is when patients with multiple chronic conditions are vulnerable to deficits in care and effective care management can prevent hospital readmissions, improve care outcomes, enhance patient experience, and reduce total health care costs? - transitional care what are the 3 components to transitional care? - interactive contact certain remote or off site services face to face visit what are these examples of: interactive contact certain remote or off site services face to face visit? - transitional care what provides financial incentives and penalties based on quality of care, outcomes, and efficiencies and is a program when the government gives additional money for electronic program that communicates between systems? - merit based incentive program what is when you exchange information across healthcare systems? - interoperability what are the 4 parts of provider performance based on for the merit based incentive program? - quality advancing care information clinical practice improvement cost/resource use
§ Prescriptive analytics § Discovery analytics? - healthcare data analytics what are the 4 types of healthcare data analytics? - § Descriptive analytics § Predictive analytics § Prescriptive analytics § Discovery analytics what are these examples of: § Researching cures for cancer § Conducting early disease detection § Improving patient documentation § Delivering telehealth services § Removing human bias for better outcomes § Managing financial error and risk? - 6 real world applications of healthcare data analytics what type of analytics are: § Unearthing new strategies § Assist with modeling and longitudinal forecasting to inform users on how to respond to a given pattern in one's data § Evidence based best practice linked to trend, so informs why there is problem and most likely solutions to get trend back on desired course § Trends, improve quality? - prescriptive analytics
what type of analytics are: § Forecasting the future § Rapidly emerging in the science of performance improvement § Provide insight on what might happen in the future based on past patterns or other criteria so that appropriate interventions may be done to achieve desired outcomes § What happened in the past to influence the future? - predictive analytics what type of analytics are these examples of: quality net web portal cerner systems and advocate health care value based purchasing calculator falls? - predictive analytics what type of analytics are: § Understanding historical trends § Describes retrospective trend or outcome ("data mining") § Reported as percentages, rates, means, medians, ratios, or counts against a target or norm § SPC analysis: examines variation within an individual process as well as timing of change § Hospital readmission rates? - descriptive analytics what superimposes the physical environment with virtual elements that have limited interaction, can be accessed through a screen which can be a smartphone or even glasses that superimpose virtual elements onto the real world, and virtual elements can be used for patient education (nutritional or pre operative information) and aiding surgery (AR assisted spinal fusion surgery-using a headset, surgeons
