Question 1
pts
Denial of provider status is something that seriously impedes a nurse practitioner’s
ability to practice. If that occurs, some steps one can take include:
Requesting that your physician colleagues intervene on your behalf by writing critical
letters to the organization in question.
Requesting that your clients lobby on your behalf by going to the newspapers.
Correct!
Writing letters to the organization’s president and chief executive officer (CEO),
activating others to lobby on your behalf, and reapplying after a 6-month period.
“Bashing” the organization to others and contacting an attorney.
There are many steps a nurse practitioner can take if denied provider status by a 3rd
party reimburser. First, one should ascertain the reasons for this stance and determine
whether it is the same across the board regarding nurse practitioners. If it is a consistent
policy, attempt to find out why and begin marshaling evidence to overturn this stance in
a constructive way. This may include having both clients and physician colleagues
“lobby” on your behalf. Find out who the decision maker in the organization is and
attempt to communicate directly with that person. Ascertain if there is a law in the state
mandating this policy. Be prepared to testify at hearings and speak out at community
meetings about this issue. Request language changes that specify “ask your doctor”
and lobby to have these changes adopted. Reapplication in 6 months is reasonable.
Question 2
pts
The phrase usual and customary refers to:
The success rate of a specified procedure.
How much an insurer will charge to provide coverage.
Correct!
How charges for a service compares with charges made to other persons receiving
similar services and supplies.
, How an insurer evaluates the need for an ordered diagnostic test.
The phrase usual and customary refers to the comparison of charges with other like
charges for services and supplies received in the immediate vicinity as well as in a
broader geographic area.
Question 3
pts
An 81-year-old patient presents for a physical. She recently had a fall and now has
problems walking up her stairs. The only restroom in the house is on the second floor.
She also has a flight of stairs outside her house she has to navigate in order to reach
street level, and this is difficult for her. Where does this information belong in your chart
note?
Review of systems.
Correct!
Functional health problems.
Plan.
Assessment.
The patient is having trouble with her normal routine and daily life due to her recent fall,
so this information belongs in the functional health patterns section.
Question 4
pts
Which of the following is the best method for evaluating the efficacy of a new clinical
intervention?
A case report.
A descriptive study.
A correlational study.
Correct!
pts
Denial of provider status is something that seriously impedes a nurse practitioner’s
ability to practice. If that occurs, some steps one can take include:
Requesting that your physician colleagues intervene on your behalf by writing critical
letters to the organization in question.
Requesting that your clients lobby on your behalf by going to the newspapers.
Correct!
Writing letters to the organization’s president and chief executive officer (CEO),
activating others to lobby on your behalf, and reapplying after a 6-month period.
“Bashing” the organization to others and contacting an attorney.
There are many steps a nurse practitioner can take if denied provider status by a 3rd
party reimburser. First, one should ascertain the reasons for this stance and determine
whether it is the same across the board regarding nurse practitioners. If it is a consistent
policy, attempt to find out why and begin marshaling evidence to overturn this stance in
a constructive way. This may include having both clients and physician colleagues
“lobby” on your behalf. Find out who the decision maker in the organization is and
attempt to communicate directly with that person. Ascertain if there is a law in the state
mandating this policy. Be prepared to testify at hearings and speak out at community
meetings about this issue. Request language changes that specify “ask your doctor”
and lobby to have these changes adopted. Reapplication in 6 months is reasonable.
Question 2
pts
The phrase usual and customary refers to:
The success rate of a specified procedure.
How much an insurer will charge to provide coverage.
Correct!
How charges for a service compares with charges made to other persons receiving
similar services and supplies.
, How an insurer evaluates the need for an ordered diagnostic test.
The phrase usual and customary refers to the comparison of charges with other like
charges for services and supplies received in the immediate vicinity as well as in a
broader geographic area.
Question 3
pts
An 81-year-old patient presents for a physical. She recently had a fall and now has
problems walking up her stairs. The only restroom in the house is on the second floor.
She also has a flight of stairs outside her house she has to navigate in order to reach
street level, and this is difficult for her. Where does this information belong in your chart
note?
Review of systems.
Correct!
Functional health problems.
Plan.
Assessment.
The patient is having trouble with her normal routine and daily life due to her recent fall,
so this information belongs in the functional health patterns section.
Question 4
pts
Which of the following is the best method for evaluating the efficacy of a new clinical
intervention?
A case report.
A descriptive study.
A correlational study.
Correct!
