ANCC Certification Exam NRSG 524 VERIFIED ANSWERS

ANCC Certification Exam NRSG 524 VERIFIED ANSWERS (4) Nurse practitioner CORRECT ANSWER - educated to practice independently at an advanced level to provide care -address health promotion, disease prevention, health education and counseling as well as the diagnosis and management of acute and chronic disease -provide initial, ongoing and comprehensive care to patients in family practice, pediatrics, internal medicine, geriatric, and women's health -practice in primary or acute care which have separate national competencies and unique certifications 6 populations of foci for nurse practitioner CORRECT ANSWER -across continuum-family -adult-gerontology primary/acute care -pediatric primary/acute care -neonatal -psychiatric mental health -women's health a NP must bill under NPI for? CORRECT ANSWER services furnished incident to your own professional services a provider's medicare benefit allows him/her to bill for? CORRECT ANSWER E&M services and the services must be provided within the scope of their practice in the state in which the provider practices a supervising physician must bill under his or her NPI for? CORRECT ANSWER services furnished incident to the physician's professional services a written prescription drug order issued pursuant to code section OCGA 43-34-25 must be signed by? and include? CORRECT ANSWER -the APRN and the delegating physician -Include the patient's name and address, drug or device ordered, directions with regards to taking and dosage of the drug or use of the device, and the number of refills -manual signature advanced skills post-graduation (learn if desired) (7) CORRECT ANSWER -prenatal 1st & 3rd trimester US -vulvar, cercial, endometrial biopsy -colposcopy -pelvic floor therapy, pessary fitting, urodynamic testing (urinary incontinence/pelvic relaxation) -first assist in cesarean sections -male circumcision -vacuum-assisted delivery all NPs must have? CORRECT ANSWER a Georgia RN license first American academy of nurse practitioners certification board (AANPCB) certifies? CORRECT ANSWER -FNP -AGPCNP -ENP American Association of Critical Care Nurses (AACN) certifies? CORRECT ANSWER AGACNP American Nurses Credentialing Center (ANCC) certifies? CORRECT ANSWER -FNP -PMHNP -AGPCNP -AGACNP APRN consensus model designed to? CORRECT ANSWER align licensure, accreditation, certification, education (LACE) APRN consensus model enables? CORRECT ANSWER practicing to full extent APRN consensus model hold at least? CORRECT ANSWER a master's degree, in addition to the initial nursing education and licensing required for all registered nurses APRN consensus model uniformity within? CORRECT ANSWER education and training standards in APRN role preparation & ensures standards are met for patient care APRN is a legal level of? CORRECT ANSWER licensure achieved and national acquisition of board certification received APRN practice is governed by? CORRECT ANSWER the GA board of nursing APRN practice is typically defined by? CORRECT ANSWER the GA Nurse Practice Act APRN role vs population foci vs APRN specialty CORRECT ANSWER APRN role: CRNA, CNM, CNS, NP population foci: family, adult/gerontology, neonatal, pediatrics, women's health, psychiatric APRN specialties: oncology, older adults, orthopedics, nephrology, palliative care, etc are split/shared services allowed in SNF? CORRECT ANSWER no authorization to refer to physical therapy, no authority, does not address CORRECT ANSWER -authority: 46 states + DC -no authority: 3 states (OK, KY, TN) -does not address: GA basic skills at graduation (core competencies) for CNMs (6) CORRECT ANSWER -vaginal delivery & labor support -Pap smears & minor diagnostic gynecology -perineal suturing & local anesthesia administration -lactation support -IUD & nexplanon contraceptive insertion -menopause management by 2020, GA will rank ____ in number of physicians to citizen's ratio? CORRECT ANSWER last can procedures by split/shared services? CORRECT ANSWER no certification exam for CNMs CORRECT ANSWER -American Midwifery Certification Board -recert q5years CNM deliveries CORRECT ANSWER national: 10% GA: almost 20% CNM education CORRECT ANSWER graduate-level (master's or doctoral) CNM salary CORRECT ANSWER -depends on practice setting, years in practice, geographical location in country -national: $105,984 -GA: $99,971 CNMs (8) CORRECT ANSWER -can deliver infants, provide prenatal & postpartum care -provide primary care & gynecologic care including contraception -reproductive health -newborn low-risk care up to 28 days of life -lactation & bereavement care -water births commercial insurers have own policy regarding reimbursement of NP services including? CORRECT ANSWER -payment at same rate as physicians without requirement of being on provider panel -payment at reduced rate -payment for NP-provided services when billed under physician name -denial of payment for NP services provided commercial insurers reimburse NPs on? CORRECT ANSWER fee-for-service basis, may adopt Medicare's rules & guidelines comprehensive exam CORRECT ANSWER a general multisystem exam or a complete exam of a single organ system cost for DEA # CORRECT ANSWER $731 for a three-year period (renewal same amount) covered health care providers and all health plans and health care clearing houses must use? CORRECT ANSWER NPIs in the administrative and financial transactions adopted under HIPAA CPT codes are developed, maintained and copyrighted by? CORRECT ANSWER the American medical association (AMA) CPT codes provide? CORRECT ANSWER a uniform language that accurately describes services rendered current procedural terminology (CPT) codes CORRECT ANSWER five-digit number code assigned to procedures or services performed by NP; serves as basis for health care billing DEA license for CNMs CORRECT ANSWER -to prescribe medications (APRN/CNM license) -specific scope of practice defined further by state legislature delegating physician CORRECT ANSWER held legally responsible for all medical acts performed by NP detailed exam CORRECT ANSWER an extended exam of the affected body area and other symptomatic or related organ system E/M guidelines levels of exam CORRECT ANSWER 1. problem focused 2. expanded problem focused 3. detailed 4. comprehensive evaluation & management (E&M) codes CORRECT ANSWER CPT codes which describe provider-patient encounters evaluation & management services refer to? CORRECT ANSWER visits and consolations furnished by providers expanded problem focused CORRECT ANSWER a limited exam of the affected body area or organ system AND other symptomatic or related organ systems four nationally recognized APRN roles CORRECT ANSWER -nurse practitioner -certified nurse midwife -clinical nurse specialist -certified registered nurse anesthetist GA needs more CNMs too? CORRECT ANSWER deliver babies GA PCP shortage CORRECT ANSWER -only 23,383 physicians hold active state licenses -only >11,000 PCPs Georgia composite medical board CORRECT ANSWER NPs seeking prescriptive authority through O.C.G.A. must submit a "nurse protocol agreement" and GCMB reviews and grants Georgia issues with healthcare (3) CORRECT ANSWER -access to care -rural hospital closures -physician shortages how long is CNM education? CORRECT ANSWER 4-6 semesters full-time around the country (Emory's program: 4 full-time semesters with part-time option) how many midwifery accredited programs nationally? CORRECT ANSWER 40 (22 have options for non-nurses) in general, managed care plans reimburse only? CORRECT ANSWER those providers admitted to the plan's provider panel; some decline NPs on the panel in incident to billing, the provider must? CORRECT ANSWER initiate a course of treatment and services done by the axillary staff including follow up care and assisting in the plan of care in incident to billing, the services provided must be? CORRECT ANSWER in the area where care is delivered and be immediately available to provide assistance and supervision in indecent to billing, the provider can be? CORRECT ANSWER a physician, nurse practitioner, clinical nurse specialist, physician's assistant, nurse midwife, clinical psychologist In NP medicare billing guidelines, you may either? CORRECT ANSWER -bill the medicare program directly for services using your NPI -have an employer or contractor bill your services using your NPI for reassigned patient LACE collaboration among? why? CORRECT ANSWER >40 nursing organization to address the inconsistency in APRN education, regulation, and practice which limited APRN mobility from one state to another LACE model CORRECT ANSWER licensure, accreditation, certification, education LACE model developed by? CORRECT ANSWER the APRN consensus work group and the national council of state boards of nursing APRN advisory committee LACE model developed in? CORRECT ANSWER 2008 medicaid programs are administered by? CORRECT ANSWER individual states, and state regulations on NP billing vary medicaid reimbursement is further complicated by many medicaid recipients being enrolled in? CORRECT ANSWER managed care plans medicare billing mechanism CORRECT ANSWER allowing services furnished in an outpatient setting to be provided by auxiliary personnel & billed under the provider's NPI number medicare makes payment only on? CORRECT ANSWER assignment medicare pays services at __% of the lesser of the actual charge or __% of the amount a physician gets under the medicare physician fee schedule CORRECT ANSWER 80%, 85% medicare pays services furnished incident to the services of an NP in a setting outside of a hospital at __% of the amount a physician gets under the Medicare PFS? CORRECT ANSWER 85% national certification corporation (NCC) certifies? CORRECT ANSWER -WHNP -NNP National Provider Identifier (NPI) CORRECT ANSWER 10-digit identification number issued in US by Centers for Medicare and Medicaid Services (CMS) no face-to-face encounter between the patient & physician (for instance, physician only reviewed the chart), only bill per? CORRECT ANSWER the NP NPI NP additional restrictions on practice CORRECT ANSWER -advanced imaging/radiographic ordering (only state left with requirement, can only order CT scans or MRIs during life-threatening emergency) -schedule II medications: not authorized -collaborative agreements and supervisory ratios: required NP authorization to sign death certificates, limited to certain circumstances, no authority CORRECT ANSWER -authority: 33 states + DC -limited to certain circumstances: 4 states (GA, TX, NJ, AK) -no authority: 13 states NP authorization to sign providers orders for life-sustaining treatment (POLST) forms CORRECT ANSWER -authority: 33 states + DC -no formal POLST form authorized in statue or regulation: 12 states -no authority: 6 states (GA, KY, MS, AR, LA, OK) NP condition of participation in the medicare program CORRECT ANSWER -NP is legally authorized & qualified to furnish services in the state where performed -services are not otherwise precluded due to statutory exclusion, and services are reasonable and necessary -services are the type considered physician's services if furnished by a MD or DO -you perform services in collaboration with a physician -medicare may cover NP assistant-at-surgery services -medicare may cover incident to services and supplies NP full practice authority (FPA) in how many states? CORRECT ANSWER 22 states + DC & 2 US territories NP milestone 1965 CORRECT ANSWER Dr. Loretta Ford, first NP (Pediatrics specialty) & Dr. Henry Silver create first NP program at University of Colorado NP milestone 1974 CORRECT ANSWER ANA created council of primary care NPs = first national certificate exams NP milestones 2008 CORRECT ANSWER APRN consensus model NP milestones 2016 CORRECT ANSWER full practice authority in the VA NP milestones 2020 CORRECT ANSWER HHS Sec. Azar advises loosening restrictions in all states; CMS temporarily loosened restrictions on NP practice during pandemic, allows NP ordering of home health services NP reimbursement (5) CORRECT ANSWER -no federal laws define or limit how private insurers recognize or reimburse NPs -Important to know how commercial insurers want to be billed for NP services -NP's may be admitted to provider panel, or not admitted to panel but still allowed to provide services when billed under a physician name -reimbursement may be full amount or reduced rate if billed under an NP's provider number -some companies may not address NP's in the contract at all (in these cases, requesting written authorization or clarification on the provision and reimbursement of NP services is valuable) NP scope of practice authority in GA CORRECT ANSWER -a written protocol is required between the NP and the supervising physician; the protocol specifies medical acts delegated by the physician and provides for immediate consultation with the physician -any person practicing or offering to practice nursing or using the title "advance practice registered nurse," as defined in O.C.G.A 43-26-1 et. seq. within the state of Georgia, shall be authorized as provided in O.C.G.A NP who has a Medicaid provider number may bill medicaid on a ? CORRECT ANSWER fee-for-service basis for physician services provided to a patient covered by medicaid if patient is not enrolled with a managed care plan NP who plans to administer, prescribe, or dispense any controlled substance must be registered with? CORRECT ANSWER federal drug enforcement administration (DEA) NPs can care for __% needed primary care services in GA CORRECT ANSWER 75% nurse protocol agreement CORRECT ANSWER a written document, mutually agreed upon and signed by an APRN and a physician by which the physician delegates to that APRN the authority to perform certain medical acts pursuant to code section 43-34-25, which may include without being limited to, the ordering of drugs, medical devices, medical treatments, diagnostic studies, or in life-threatening situations radiographic imaging tests OCGA rule CORRECT ANSWER used when an APRN does not write prescriptions but calls prescriptions in under the physician's name OCGA rule CORRECT ANSWER an NP may prescribe schedule III-V controlled substances if the NP is authorized to prescribe and has submitted the written protocol with the supervising physician office/clinic setting: for encounters with established patients that meet incident to billing requirements, report using? CORRECT ANSWER the physician's NPI parking permits for proof of disabled parking authority vs no authority CORRECT ANSWER -authority: 48 states + DC -no authority: 2 states (SD & GA) payment is made directly to the NP for assistant-at-surgery services at __% of the lesser of the actual charge or __% of __% of the amount a physician gets under the Medicare PFS CORRECT ANSWER 80%, 85%, 16% Pediatric nursing certification board (PNCB) certifies? CORRECT ANSWER -PPCNP -PPACNP problem focused CORRECT ANSWER a limited exam of the affected body area or organ system ratio limitations: collaborative or supervisory agreements (reduced or restricted states) CORRECT ANSWER -no ratios (FPA states): 22 states + DC -no ratios (not FPA states): 18 states -yes ratios: 10 states (AL, FL, MO, OK, TX, CA, VA, NY, OH, GA) report only the AS modifier on claim form when NP bills? CORRECT ANSWER assistant-at-surgery services result of APRN regulation CORRECT ANSWER Consensus Model for APRN regulation: LACE Model: Licensure, Accreditation, Certification, Education scheduled II prescriptive authority, limited to hydrocodone combo products, no authority CORRECT ANSWER -authority: 44 states + DC -limited to hydrocodone combo products: 2 states (MO & AR) -no authority: OK, WV, AL, GA some examples per medicare for conditions of participation? CORRECT ANSWER -taking the patient's history, performing a physical exam, and ordering appropriate laboratory tests and procedures -diagnosing, treating, and managing acute and chronic diseases -providing prescriptions and coordinating referrals -promoting healthy activities in collaboration with the patient split/share service CORRECT ANSWER an encounter where a physician and a NP each personally perform a portion of an evaluation and management (E/M) visit form the same practice -physician provided face-to-face portion with same patient -E&M encounter with the patient, the service may be billed under the physician's or the APRN's NPI number standardization of licensure, accreditation, certification, and education aimed to? CORRECT ANSWER improve access to APRN care state level restrictions (Medicaid and/or Nurse Practice Act) can? CORRECT ANSWER prevent NP's from performing certain procedures (GA requirement for a collaborative agreement with physician) third parties (insurers) use CPT codes to determine? CORRECT ANSWER amount of reimbursement to be paid to NP three key components required when selecting the appropriate level of E&M service provided CORRECT ANSWER -history -examination -medical decision making (visits that consist primarily for counseling and/or coordination of care are an exception to the rule) total CNMs CORRECT ANSWER national: 11,878 GA: 575 two statues in GA regarding scope of prescriptive authority CORRECT ANSWER -OCGA 43-34-23 (nurse protocol agreements without prescriptive authority) -OCGA 43-34-25 (nurse protocol agreements with prescriptive authority) typical day for a CNM (hospital-based) CORRECT ANSWER -12-24 hours on-call shifts 1-2x/week delivering babies for the practice (sleep at hospital) usually with nest day or afternoon off -more days spent in office seeing patients with shorter appointment times -less likely to do home visits, newborn care, or home-birthing -many CNMs focus on prenatal care but there are many others practicing "full-scope" midwifery to include gynecology & menopause management typical day for CNM in free-standing birth center or home-based CORRECT ANSWER -most day spent on-call for laboring patients while also seeing patients in office -typically more focused on prenatal care & birth prep with limited gyn focus -longer appointment times allows for more education-based visits -In-home visits for lactation or postpartum & newborn assessments -may provide personal delivery services to a patent or share among midwives under GA law, only ___ can prescribe Schedule II medications? CORRECT ANSWER physicians what settings can a CNM work? (10) CORRECT ANSWER -hospitals -free-standing birth centers -home of patient -private OB/GYN &/or midwifery practices -HMO organizations (Kaiser Permanente) -federal, state, local/community funded clinics -maternal-fetal medicine (perinatology) clinics -VA facilities or active duty military installations -urogynecology, reproductive/infertility clinics or women's health clinics -global outreach (doctors without borders & LLC service area) when you bill directly for services to hospital inpatients and outpatients... CORRECT ANSWER payment is unbundled and made to the NP who collects identifying information on health care providers and assigns each a unique NPI#? CORRECT ANSWER national plan and provider enumeration system why does scope of practice matter nationally? (3) CORRECT ANSWER -more healthcare providers needed -growing population increasing older population -underserved areas with physician shortages why is GA in the red? CORRECT ANSWER -scope of practice authority -NPs are not explicitly recognized in state policy as PCPs -NP additional restrictions on practice with a DEA number, the NP may prescribe? CORRECT ANSWER regular prescriptions schedule III-V controlled substance medications, but not schedule II without a DEA number, NP can? CORRECT ANSWER -not prescribe any scheduled drugs -may only write regular prescriptions (such as abx)