NR 511 WEEKLY Q & A
Question 1
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 Answer
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.
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:
“Bashing” the organization to others and contacting an attorney.
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.
, Requesting that your clients lobby on your behalf by going to the newspapers.
Requesting that your physician colleagues intervene on your behalf by writing critical letters to the
organization in question.
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.
Which of the following statements about Medicaid is true?
Medicaid pays for family planning services, dental care, and eyeglasses.
Medicaid is a federal plan created to provide care for indigent persons.
Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration.
Medicaid is a program for the indigent financed jointly by the federal and state governments.
Financed jointly by the federal and state governments, Medicaid is a program created to pay for health care
services for the indigent. Minimally, Medicaid must provide inpatients, skilled nursing facility, and home care;
physician services, outpatients care; family planning services; and periodic sreening, detection, and
treatment of children under age 12.
Question 2
pts
What must you do as an advanced practice registered nurse (APRN) before billing for visits?
Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer.
Provide evidence of continuing medical education
Obtain a Drug Enforcement Administration (DEA) number.
Question 1
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 Answer
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.
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:
“Bashing” the organization to others and contacting an attorney.
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.
, Requesting that your clients lobby on your behalf by going to the newspapers.
Requesting that your physician colleagues intervene on your behalf by writing critical letters to the
organization in question.
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.
Which of the following statements about Medicaid is true?
Medicaid pays for family planning services, dental care, and eyeglasses.
Medicaid is a federal plan created to provide care for indigent persons.
Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration.
Medicaid is a program for the indigent financed jointly by the federal and state governments.
Financed jointly by the federal and state governments, Medicaid is a program created to pay for health care
services for the indigent. Minimally, Medicaid must provide inpatients, skilled nursing facility, and home care;
physician services, outpatients care; family planning services; and periodic sreening, detection, and
treatment of children under age 12.
Question 2
pts
What must you do as an advanced practice registered nurse (APRN) before billing for visits?
Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer.
Provide evidence of continuing medical education
Obtain a Drug Enforcement Administration (DEA) number.
