Discuss the Public Policies Affecting Nurse Practice Management – , such as reimbursement, billing and coding, and collaborative agreements. Compare the advantages and disadvantages of the types of business structures.
Solution
Public Policies Affecting Nurse Practice Management
New Jersey Public Policies
Public health policies are essential in developing guidelines beneficial to patients, healthcare organizations, and nurse practitioners. New Jersey (N.J.) has public policies guiding nurse practice management, such as reimbursements, coding and billing, and collaborative agreements. For instance, Section 10:58A-1.5 of the N.J. reimbursement policy requires reimbursement of the services of an Advanced Practice Registered Nurse (APRN) through a fee-for-service (FFS) basis. It means the patients must cover the medical services for all the treatment aspects accorded to them (Casetext, 2022). Additionally, the APRNs charge the services based on the direct billing entity or through Medicaid/NJ FamilyCare providers who bill the services on behalf of the physician.
The hospitals or family health services have APRNs salaried through the N.J. Medicaid/ Family Care FFS programs. In this case, they must bill the patients using their assigned N.J. Medicaid/ Family Care numbers. Furthermore, Casetext (2022) 0bserves that independently reimbursed APRNs bill patients based on the prevailing charges across hospitals within the community where they rendered the services. It should not be more than the “maximum fee allowance schedule.” Consequently, the N.J. 13:37-7.9 policy on collaborative agreements requires the APRNs to cooperate with an attending physician by assigning a joint protocol. The APRNs can prescribe schedule II to V medications, medical devices, and other controlled substances during the collaboration.
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Advantages and Disadvantages
The nurse practice management in N.J. involves Medicaid or NJ FamilyCare FFS business structures. The NJ Medicaid is advantageous since it offers affordable health services to patients (Powell, 2019). It also provides improved health and care coordination. However, it doesn’t cover every treatment aspect, such as emergency care or dental and outpatient services. It also limits patients’ options only to the available treatment type.
On the other hand, the NJ FamilyCare FFS is readily available and can provide emergency services (New Jersey FamilyCare, n.d). Also, beneficiaries can decide on the type of treatment they want. Moreover, the care structure is flexible depending on the beneficiaries’ financial potential. Its disadvantages include high treatment costs and require beneficiaries to cover upfront costs (Powell, 2019). Also, the FFS program does not hold medical providers accountable for their services, making it challenging to win disputes against them.
References
Casetext (2022). N.J. Admin. Code § 10:58A-1.5. Casetext Research. Available at: https://casetext.com/regulation/new-jersey-administrative-code/title-10-human-services/chapter-58a-advanced-practice-nurse-services/subchapter-1-general-provisions/section-1058a-15-basis-of-reimbursement (Accessed: 7 July 2022)
New Jersey FamilyCare (n.d). What is New Jersey FamilyCare (NJFC)? Benefits.Gov. Available at: https://www.benefits.gov/benefit/1315 (Accessed: 7 July 2022)
Powell, S. K. (2019). Choosing Medicare Advantage plans versus traditional fee-for-service: is this change the tipping point? Professional Case Management, 24(1), 1-3.
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