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 Asso ciation
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 fir st. How should the services be
billed to CMS using shared service guidelines?
a. Combined and billed under the NP’s provider number
b. Billed separatel y 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. Additionall y, 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 -complexit y 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 separatel y because
care provided by NPs and PAs is billed at a lo wer 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 i n 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 separatel y
and also cannot be combined or linked.
5. Which of the following is a specialization opportunit y most appropriate
for an AG-ACNP?
a. Rapid response ream
b. Advanced diabetes manager
c. Outpatient clinic supervisor
d. Wound ostom y nurse
ANS: A
Although the AG -ACNP may be eligible to specialize in all of the
areas, he or she would best be suited for a specialization that utilizes
the acute care nature of his or her skills.
6. All of the following are reasons that attributed to the rise of AG -ACNP
except:
a. Intensivist physician shortages
b. Rising cost of malpractice insurance for physicians
c. Changes to medical resident work hour restrictions
d. Increase in patients with complex medical conditions
ANS: B
The role of AG -ACNP rose out of an increased demand for
practitioners to manage patients with complex medical conditions,
shortages of intens ivist physicians, and changes to medical resident
and fellows work hour restrictions.
, 7. An increased spectrum of care affords the AG -ACNP the ability to provide
medical care to a broader age group. Which of the following is age -range
appropriate for an AG -ACNP to treat?
a. Age 7 and older
b. Age 13 and older
c. Age 18 and older
d. Age 21 and older
ANS: B
An AG-ACNP can provide care to patients aged 13 and older unless
additional state or facilit y- specific restrictions exist. The age ranges
are grouped into youn g adults, middle -age adults, and older adults.
8. As identified in a 2012 study by the ANCC, which of the following top
workactivities for the AG -ACNP was number one when arranged by
criticalit y?
a. Conducting history and physical examinations
b. Maintaining patient privacy and confidentialit y
c. Evaluating patients for safet y and efficacy of interventions
d. Assessing patients for urgent and emergent conditions
ANS: B
In 2012, the ANCC surveyed ACNP clinicians and identified top work
activities for the AG -ACNP role. These activities were organized by
criticalit y, or importance of the skill and determined by the
requirement to perform the skill accurately each time, as a novice NP,
and based on the risk of harm by performing the skill incorrectly.
Maintaining patient privacy and confidentialit y scored at the top.
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 Asso ciation
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 fir st. How should the services be
billed to CMS using shared service guidelines?
a. Combined and billed under the NP’s provider number
b. Billed separatel y 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. Additionall y, 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 -complexit y 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 separatel y because
care provided by NPs and PAs is billed at a lo wer 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 i n 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 separatel y
and also cannot be combined or linked.
5. Which of the following is a specialization opportunit y most appropriate
for an AG-ACNP?
a. Rapid response ream
b. Advanced diabetes manager
c. Outpatient clinic supervisor
d. Wound ostom y nurse
ANS: A
Although the AG -ACNP may be eligible to specialize in all of the
areas, he or she would best be suited for a specialization that utilizes
the acute care nature of his or her skills.
6. All of the following are reasons that attributed to the rise of AG -ACNP
except:
a. Intensivist physician shortages
b. Rising cost of malpractice insurance for physicians
c. Changes to medical resident work hour restrictions
d. Increase in patients with complex medical conditions
ANS: B
The role of AG -ACNP rose out of an increased demand for
practitioners to manage patients with complex medical conditions,
shortages of intens ivist physicians, and changes to medical resident
and fellows work hour restrictions.
, 7. An increased spectrum of care affords the AG -ACNP the ability to provide
medical care to a broader age group. Which of the following is age -range
appropriate for an AG -ACNP to treat?
a. Age 7 and older
b. Age 13 and older
c. Age 18 and older
d. Age 21 and older
ANS: B
An AG-ACNP can provide care to patients aged 13 and older unless
additional state or facilit y- specific restrictions exist. The age ranges
are grouped into youn g adults, middle -age adults, and older adults.
8. As identified in a 2012 study by the ANCC, which of the following top
workactivities for the AG -ACNP was number one when arranged by
criticalit y?
a. Conducting history and physical examinations
b. Maintaining patient privacy and confidentialit y
c. Evaluating patients for safet y and efficacy of interventions
d. Assessing patients for urgent and emergent conditions
ANS: B
In 2012, the ANCC surveyed ACNP clinicians and identified top work
activities for the AG -ACNP role. These activities were organized by
criticalit y, or importance of the skill and determined by the
requirement to perform the skill accurately each time, as a novice NP,
and based on the risk of harm by performing the skill incorrectly.
Maintaining patient privacy and confidentialit y scored at the top.
