,
A,nurse,practitioner,has,agreed,to,participate,in,the,Medicare,health,insurance,program.,Medicare,
paid,80%,of,the,charges,billed,for,a,clinic,visit.,What,can,be,done,about,the,other,20%,that,is,owed?
,
The,NP,can,bill,the,patient,for,a,percentage,of,the,remainder.,The,NP,is,prohibited,fro
m,billing,the,patient.,
The,NP,can,collect,90%,if,billed,incident,to,the,MD.,The,NP,can,resub
mit,the,bill,for,additional,payment.,
The,NP,is,a,“participating”,provider,because,he,agreed,to,accept,assignments.,An,assignment,is,an,ag
reement,between,Medicare,and,the,NP,to,accept,the,Medicare,Approved,Amount,(MAA),as,paymen
t,in,full,and,not,charge,Medicare,recipients,a,higher,rate.,The,NP,can,bill,the,patient,for,a,percentage,
of,the,remaining,bill,that,was,not,paid,by,Medicare.,The,NP,may,opt,out,of,participating.,The,NP,can,
be,reimbursed,100%,if,billed,incident,to,the,MD.,
The,name,given,to,subjects,in,a,research,study,who,do,not,have,the,disease,or,condition,being,studied,,
but,who,are,included,in,the,study,for,comparison,are:,
studied,subjects.,controls.,
case,series.,cross,sectionals.,
Studied,subjects,are,those,members,of,a,study,who,have,a,specific,disease,or,condition,of,interest,or,wh
o,are,receiving,a,specific,treatment.,Case,series,may,refer,to,an,observational,study,in,which,a,group,of,
patients,with,interesting,characteristics,are,studied.,Cross,sectional,is,a,type,of,observational,study,in,w
hich,a,particular,characteristic,is,studied,at,one,time,rather,than,over,time.,Controls,are,commonly,empl
oyed,in,many,types,of,research,studies.,
The,research,design,that,provides,the,strongest,evidence,for,concluding,causation,is:,randomized,controll
ed,trials.,cohort,studies.,case,control,studies.,prospective,studies.,
A,randomized,clinical,trial,(RCT),is,the,epitome,of,all,research,designs.,Subjects,are,randomly,assigned,to,tr
eatment,groups.,This,type,study,provides,the,best,evidence,that,the,results,were,due,to,the,intervention,a
nd,not,something,else.,A,RCT,is,an,experimental,design,,not,an,observational,one.,
, An,older,adult,male,with,moderately,severe,dementia,presents,with,his,caregiver,daughter.,His,BMI,is,
18.,His,clothes,have,food,stains,on,them,and,he,looks,as,though,he,hasn’t,been,bathed,in,days.,How,sh
ould,the,nurse,practitioner,handle,this?,The,NP,should,comment,to,the,daughter,about,his,poor,care.,
The,NP,should,report,this,as,potential,elder,abuse.,
The,patient,should,be,asked,about,his,care.,
,
The,daughter,should,be,asked,about,the,type,of,care,he,receives.,
,
This,patient,presents,as,though,he,is,being,poorly,cared,for,and,mistreated.,This,occurs,in,about,3-
8%,of,the,adult,population,in,the,United,States.,There,is,no,evidence,that,the,patient,has,been,physicall
y,abused,,but,he,obviously,suffers,from,neglect.,This,is,a,form,of,elder,abuse,,just,as,physical,,sexual,,psy
chological,,or,financial,abuse,is.,Older,adults,with,dementia,often,suffer,abuse,most,frequently.,
A,nurse,practitioner,is,working,in,a,minor,care,area,of,an,emergency,department.,An,illegal,immigrant,h
as,a,puncture,wound,caused,by,an,unknown,sharp,object,in,a,trash,container.,A,dirty,needle,is,suspecte
d.,The,nurse,practitioner:,
Should,administer,a,tetanus,injection,only,since,the,patient,has,no,medical,insurance.,
Should,prescribe,appropriate,medications,for,HIV,exposure,even,though,the,nurse,practitioner,knows,the,
patient,can’t,afford,them.,
Should,not,mention,the,possibility,of,HIV,exposure,from,a,dirty,needle,to,the,patient.,
Can,offer,to,buy,the,HIV,medications,for,$50,with,their,professional,discount,at,the,pharmacy,next,door.
,
The,standard,of,care,followed,by,the,nurse,practitioner,should,not,depend,on,whether,the,patient,has,insu
rance,or,not.,It,is,unethical,to,not,properly,inform,the,patient,of,risks,he,may,have,been,exposed,to,from,t
he,puncture,wound.,Offering,to,buy,the,medications,for,the,patient,is,noble,but,is,not,a,sustainable,practic
e.,The,nurse,practitioner,should,prescribe,the,medications,as,for,anyone,with,possible,HIV,exposure,and,r
efer,to,social,services,or,a,community,referral,agency,that,can,help,this,patient,acquire,the,appropriate,me
dications.,
A,nurse,practitioner,is,working,in,a,minor,care,clinic.,She,realizes,that,a,patient,with,a,minor,laceration,
does,not,have,insurance,and,is,using,his,brother’s,insurance,information,today,so,that,his,visit,will,be,c
overed.,How,should,she,proceed?,She,should,let,him,know,that,she,knows,what,he,is,doing.,She,should
,ignore,this,and,proceed,to,suture,his,wound.,
She,should,let,the,clinic's,business,office,know,what,is,happening.,She,should,not,sut
ure,his,wound,and,ask,him,to,leave.,
The,nurse,practitioner,cannot,ignore,the,fact,that,this,patient,is,attempting,to,defraud,the,clinic,and,insu
rance,company,in,order,to,receive,free,care.,If,she,does,not,let,the,business,office,know,,she,is,a,party,to
A,nurse,practitioner,has,agreed,to,participate,in,the,Medicare,health,insurance,program.,Medicare,
paid,80%,of,the,charges,billed,for,a,clinic,visit.,What,can,be,done,about,the,other,20%,that,is,owed?
,
The,NP,can,bill,the,patient,for,a,percentage,of,the,remainder.,The,NP,is,prohibited,fro
m,billing,the,patient.,
The,NP,can,collect,90%,if,billed,incident,to,the,MD.,The,NP,can,resub
mit,the,bill,for,additional,payment.,
The,NP,is,a,“participating”,provider,because,he,agreed,to,accept,assignments.,An,assignment,is,an,ag
reement,between,Medicare,and,the,NP,to,accept,the,Medicare,Approved,Amount,(MAA),as,paymen
t,in,full,and,not,charge,Medicare,recipients,a,higher,rate.,The,NP,can,bill,the,patient,for,a,percentage,
of,the,remaining,bill,that,was,not,paid,by,Medicare.,The,NP,may,opt,out,of,participating.,The,NP,can,
be,reimbursed,100%,if,billed,incident,to,the,MD.,
The,name,given,to,subjects,in,a,research,study,who,do,not,have,the,disease,or,condition,being,studied,,
but,who,are,included,in,the,study,for,comparison,are:,
studied,subjects.,controls.,
case,series.,cross,sectionals.,
Studied,subjects,are,those,members,of,a,study,who,have,a,specific,disease,or,condition,of,interest,or,wh
o,are,receiving,a,specific,treatment.,Case,series,may,refer,to,an,observational,study,in,which,a,group,of,
patients,with,interesting,characteristics,are,studied.,Cross,sectional,is,a,type,of,observational,study,in,w
hich,a,particular,characteristic,is,studied,at,one,time,rather,than,over,time.,Controls,are,commonly,empl
oyed,in,many,types,of,research,studies.,
The,research,design,that,provides,the,strongest,evidence,for,concluding,causation,is:,randomized,controll
ed,trials.,cohort,studies.,case,control,studies.,prospective,studies.,
A,randomized,clinical,trial,(RCT),is,the,epitome,of,all,research,designs.,Subjects,are,randomly,assigned,to,tr
eatment,groups.,This,type,study,provides,the,best,evidence,that,the,results,were,due,to,the,intervention,a
nd,not,something,else.,A,RCT,is,an,experimental,design,,not,an,observational,one.,
, An,older,adult,male,with,moderately,severe,dementia,presents,with,his,caregiver,daughter.,His,BMI,is,
18.,His,clothes,have,food,stains,on,them,and,he,looks,as,though,he,hasn’t,been,bathed,in,days.,How,sh
ould,the,nurse,practitioner,handle,this?,The,NP,should,comment,to,the,daughter,about,his,poor,care.,
The,NP,should,report,this,as,potential,elder,abuse.,
The,patient,should,be,asked,about,his,care.,
,
The,daughter,should,be,asked,about,the,type,of,care,he,receives.,
,
This,patient,presents,as,though,he,is,being,poorly,cared,for,and,mistreated.,This,occurs,in,about,3-
8%,of,the,adult,population,in,the,United,States.,There,is,no,evidence,that,the,patient,has,been,physicall
y,abused,,but,he,obviously,suffers,from,neglect.,This,is,a,form,of,elder,abuse,,just,as,physical,,sexual,,psy
chological,,or,financial,abuse,is.,Older,adults,with,dementia,often,suffer,abuse,most,frequently.,
A,nurse,practitioner,is,working,in,a,minor,care,area,of,an,emergency,department.,An,illegal,immigrant,h
as,a,puncture,wound,caused,by,an,unknown,sharp,object,in,a,trash,container.,A,dirty,needle,is,suspecte
d.,The,nurse,practitioner:,
Should,administer,a,tetanus,injection,only,since,the,patient,has,no,medical,insurance.,
Should,prescribe,appropriate,medications,for,HIV,exposure,even,though,the,nurse,practitioner,knows,the,
patient,can’t,afford,them.,
Should,not,mention,the,possibility,of,HIV,exposure,from,a,dirty,needle,to,the,patient.,
Can,offer,to,buy,the,HIV,medications,for,$50,with,their,professional,discount,at,the,pharmacy,next,door.
,
The,standard,of,care,followed,by,the,nurse,practitioner,should,not,depend,on,whether,the,patient,has,insu
rance,or,not.,It,is,unethical,to,not,properly,inform,the,patient,of,risks,he,may,have,been,exposed,to,from,t
he,puncture,wound.,Offering,to,buy,the,medications,for,the,patient,is,noble,but,is,not,a,sustainable,practic
e.,The,nurse,practitioner,should,prescribe,the,medications,as,for,anyone,with,possible,HIV,exposure,and,r
efer,to,social,services,or,a,community,referral,agency,that,can,help,this,patient,acquire,the,appropriate,me
dications.,
A,nurse,practitioner,is,working,in,a,minor,care,clinic.,She,realizes,that,a,patient,with,a,minor,laceration,
does,not,have,insurance,and,is,using,his,brother’s,insurance,information,today,so,that,his,visit,will,be,c
overed.,How,should,she,proceed?,She,should,let,him,know,that,she,knows,what,he,is,doing.,She,should
,ignore,this,and,proceed,to,suture,his,wound.,
She,should,let,the,clinic's,business,office,know,what,is,happening.,She,should,not,sut
ure,his,wound,and,ask,him,to,leave.,
The,nurse,practitioner,cannot,ignore,the,fact,that,this,patient,is,attempting,to,defraud,the,clinic,and,insu
rance,company,in,order,to,receive,free,care.,If,she,does,not,let,the,business,office,know,,she,is,a,party,to
