Reference no: EM133229198

Question: There are several subtopics under the rubric of reimbursement to be covered this week:

Understanding Medicare reimbursement and "incident to" is paramount to an APRN's career (NOTE: Strictly speaking the term incident to is a Medicare expression. While some commercial insurance companies and some states' Medicaid plans might mimic this practice, they do not necessarily require all of the associated Medicare criteria.)

The first question you must address is: Should the organization use "incident to" billing? Why or why not? In other words, you first need to explain what Medicare requires for an organization to legitimately bill incident to. Next you need to explain whether incident to billing makes financial sense for your organization in light of Medicare criteria. Be sure to read the Buppert and Nagelkerk assignments carefully before you compose an answer. Finally, also based on those reading assignments, briefly share some thoughts about billing Medicaid and commercial insurance companies for APRN services.

The next topic concerns how your organization can avoid Medicare fraud and abuse when using APNs; specifically regarding the Stark Acts: What do you and the APNs in your organization have to know about this?