Chapter 6. Advanced Practice Nurses and
Prescriptive Authority
1. Which of the following organizations issue certification for AG-ACNPs?
a. American Nurses Credentialing Center and the American Association of
Gerontology
b. The state where he or she intends to practice
c. American Nurses Credentialing Center and the American Association of Critical-
Care
d. American Association of Critical-Care and the Emergency Nurses Association
ANS: C
American Nurses Credentialing Center and the American Association of CriticalCare
issue certification for the AG-ACNP program.
2. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs.
The NP and a physician in the group both evaluate a patient on the same day. The NP
seesthe patient first. How should the services be billed to CMS using shared service
guidelines?
a. Combined and billed under the NP’s provider number
b. Billed separately under each provider’s individual number
c. Combined and billed under the physician’s provider number
d. Billed under the AG-ACNP’s provider number
ANS: C
Shared E/M services can be billed under CMS guidelines as combined services if both
the NP and the physician see the patient in a face-to-face visit on the same calendar
day, regardless of order. If the physician does not have a face-to-face encounter the
, services should be billed under the NP’s provider number. Additionally, critical care
time cannot be billed under shared billing.
3. How are provided critical care services billed by AG-ACNPs according to CMS?
a. Standard charge per face-to-face encounter
b. As part of DRG allocation monies bundled with hospitalist services
c. Single charge per calendar day of service
d. The number of critical care minutes spent
ANS: D
Critical care involves high-complexity decision making in the care of patients.
Reimbursement is based on the number of critical care time in minutes spent by the
provider and must be billed separately because care provided by NPs and PAs is
billed at a lower rate. The first 30-74 minutes are billed and then separate billing for
each additional 30 minutes of critical care time spent with the patient.
4. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs.
The NP and a physician in the group both evaluate a patient in the intensive care unit. The
NP assesses and evaluates the patient first for 32 minutes followed by the physician for
20 minutes. How should the initial critical care time be billed?
a. Combined and billed under the NP’s provider number
b. Combined and billed under the physician’s provider number
c. Billed under the AG-ACNP’s provider number
d. Billed under the physician’s provider number
ANS: C
Billing of critical care time for the initial 30 minutes is billed under the provider
number of whoever provided the service. It cannot be combined. Subsequent critical
care minutes should be billed separately and also cannot be combined or linked.
Prescriptive Authority
1. Which of the following organizations issue certification for AG-ACNPs?
a. American Nurses Credentialing Center and the American Association of
Gerontology
b. The state where he or she intends to practice
c. American Nurses Credentialing Center and the American Association of Critical-
Care
d. American Association of Critical-Care and the Emergency Nurses Association
ANS: C
American Nurses Credentialing Center and the American Association of CriticalCare
issue certification for the AG-ACNP program.
2. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs.
The NP and a physician in the group both evaluate a patient on the same day. The NP
seesthe patient first. How should the services be billed to CMS using shared service
guidelines?
a. Combined and billed under the NP’s provider number
b. Billed separately under each provider’s individual number
c. Combined and billed under the physician’s provider number
d. Billed under the AG-ACNP’s provider number
ANS: C
Shared E/M services can be billed under CMS guidelines as combined services if both
the NP and the physician see the patient in a face-to-face visit on the same calendar
day, regardless of order. If the physician does not have a face-to-face encounter the
, services should be billed under the NP’s provider number. Additionally, critical care
time cannot be billed under shared billing.
3. How are provided critical care services billed by AG-ACNPs according to CMS?
a. Standard charge per face-to-face encounter
b. As part of DRG allocation monies bundled with hospitalist services
c. Single charge per calendar day of service
d. The number of critical care minutes spent
ANS: D
Critical care involves high-complexity decision making in the care of patients.
Reimbursement is based on the number of critical care time in minutes spent by the
provider and must be billed separately because care provided by NPs and PAs is
billed at a lower rate. The first 30-74 minutes are billed and then separate billing for
each additional 30 minutes of critical care time spent with the patient.
4. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs.
The NP and a physician in the group both evaluate a patient in the intensive care unit. The
NP assesses and evaluates the patient first for 32 minutes followed by the physician for
20 minutes. How should the initial critical care time be billed?
a. Combined and billed under the NP’s provider number
b. Combined and billed under the physician’s provider number
c. Billed under the AG-ACNP’s provider number
d. Billed under the physician’s provider number
ANS: C
Billing of critical care time for the initial 30 minutes is billed under the provider
number of whoever provided the service. It cannot be combined. Subsequent critical
care minutes should be billed separately and also cannot be combined or linked.
