answer to each classmate 4 sentece per peer response is fine 1 reference per e

answer to each classmate 4 sentece per peer response is fine 1 reference per each calssmate respone Advanced practice registered nurses (APRNs) must consistently demonstrate expertise in clinical skills while balancing an expertise in navigating the third-party payer rules in an uncertain, ever-changing health-care landscape. APRNs have demonstrated the ability to administer high-quality health-care services in a variety of settings with the cost of care significantly less than that of internal medicine and specialty physicians. Whether providing services under the direct supervision of a physician or through a collaborative agreement, the successful APRN must not only understand the clinical skills required to provide care, but also that the cost of providing that care affects the provider as well as the patient.
Case Questions
classmate 1 What are the general categories of third-party payers? What do they have in common?
Third party payers fall into seven general categories, “medicare, medicaid, indeminty insurance companies, managed care organizations, workers compensation, veterans administration, auto liability”(Dunphy et al, 2020, pg 1328). Something that they all have in common is they use guidelines provided by the CMS, the federal agency that runs the Medicare program. CLASSMATE 2
It is recommended that patient responsibility payments be collected before services are rendered. Why is this important?
The longer money goes uncollected, the less likely it will be collected.
CLASSMATE 3 What should you understand before entering into a contractual or employee–employer relationship with an “opting-out†physician?
I need to understand that the practice has a different insurance coverage, a malpractice coverage may have a different clause or security clause, referral process is limited and that the NP working for an “opting out†physician will not be able to bill as a Medicare participating physician for NP services. Also, the NPs are at higher risk to be appointed on a malpractice claim (Dunphy et al., 2019).
What are the differences between The Merit-based Incentive Payment System (MIPS) and The Advanced Alternative Payment Model (Advanced APM)?
Advanced APM is for providers who take on added risks when treating their patients while bringing high-quality care. Merit-based Incentive Payment System (MIPS) is a performance-based payment system that offers clinicians the flexibility to select the activities and measures most beneficial to their practice.
Appropriate clinician’s performance is weighted in each of the 4 performance categories, then combined for their MIPS final score. The MIPS final score is used to determine Medicare Part B payment adjustments in upcoming years.