Critical Practice Management... | Buy

Managing the business side of a clinical practice is the focus of this book, which is aimed at nurse practitioners who want to expand their roles and responsibilities in primary care delivery. The business principles and practices covered in this book: finances, budgeting, and billing; health care funding; employment choices; managed care; quality, clinical performance and the bottom line care basic to developing the skills and strategies that NPs need to succeed in this area.

Using This Book

vii

Business Concepts in Practice Management: An Introduction

1

(10)

Background

1

(1)

Financial Position of a Practice

2

(7)

Balance Sheet

2

(1)

Operating Statement (Income Statement)

2

(1)

Cash Flow

3

(1)

Budgeting

3

(2)

Costs

5

(4)

Variance Analysis

9

(1)

Conclusion

10

(1)

References

10

(1)

Health Care Funding in the United States

11

(22)

Introduction

11

(1)

The Growth of Insurance

11

(1)

The Concept of Risk

12

(1)

Funding of Health Care

12

(15)

Pubic Funding

12

(1)

Medicare

12

(8)

Example of Incident to Billing

20

(1)

Medicaid

20

(2)

State Children's Health Insurance Program

22

(1)

Governmental Programs for Specific Groups

23

(1)

Rural Health Clinics

23

(2)

Private Funding of Health Care

25

(1)

Direct Payment to Practitioners

25

(1)

Self-Insurance by Employers

25

(1)

Nonprofit Insurance

26

(1)

Commercial Insurance

26

(1)

Benefits and Provider Panels in Private Insurance

27

(1)

Provider Relationships with Health Plans

27

(2)

Impact of Reimbursement on Business Strategy

29

(1)

Conclusion

30

(1)

Additional Resources

30

(1)

References

30

(3)

The Impact of Managed Care

33

(20)

Introduction

33

(1)

Managed Care Models

34

(2)

Changes in Reimbursement Mechanisms

36

(4)

Restricting the Provider Panel

40

(1)

Changes to Less Expensive Providers

41

(1)

Changing the Practice Patterns

41

(2)

Managed Care Penetration

43

(4)

Managed Medicare

46

(1)

Managed Medicaid

46

(1)

Negotiating a Managed Care Contract

47

(1)

Antitrust Issues

47

(5)

Conclusion

52

(1)

Resources

52

(1)

References

52

(1)

Billing Issues for the Nurse Practitioner

53

(24)

ICD-9-CM Diagnostic Codes

53

(1)

History

53

(1)

Documentation of Examination

53

(7)

Medical Decision Making

60

(2)

Numbers of Diagnoses or Management Options

62

(3)

Proper Documentation

62

(1)

Quantifying Numbers of Diagnoses and Management Options

63

(2)

Amount and/or Complexity of Data to be Retrieved

65

(1)

What Determines Complexity?

65

(1)

Document Complexity

65

(1)

Risk of Significant Complications, Morbidity, and/or Mortality

66

(1)

Time as a Factor

66

(1)

Counseling Time

67

(1)

E/M Documentation Guidelines

67

(5)

When Claims Are Rejected

72

(2)

Relationship of Documentation and Billing

74

(1)

Conclusion

75

(1)

References

75

(2)

Employment Choices for the Nurse Practitioner

77

(12)

Introduction

77

(1)

Self-Employed Nurse Practitioner

78

(5)

Impact of Patient Flow on Practice Profitability

78

(2)

Types of Business Structures

80

(1)

Development of a Business Plan

80

(3)

The Nurse Practitioner as an Employee

83

(2)

Independent Contractors

85

(1)

Ethical Issues

85

(2)

Conclusion

87

(1)

References

87

(2)

Clinical Performance and Its Effect on Quality and the Bottom Line

89

(18)

Introduction

89

(1)

The Concept of Quality

89

(1)

History of Quality Measurement

90

(1)

Continuous Quality Improvement and Total Quality Management

90

(1)

Outcomes in Primary Care

91

(4)

Instruments

91

(4)

Patient Satisfaction

95

(1)

Incentives for Measurement

95

(1)

Culturally and Linguistically Competent Care

96

(3)

Preventive Protocols

99

(1)

Quality Dividend Calculator

99

(2)

Risk Management

101

(2)

Hand-Held Technological Support

103

(1)

Conclusion

104

(1)

Resources

104

(1)

References

105

(2)

Health Care and Business: What's in the Future?

107

(4)

Introduction

107

(1)

The Forecast

107

(3)

Increased Life Expectancy

108

(1)

Increased Education

108

(1)

Increased Diversity

108

(1)

Tiered Access to Care

109

(1)

Increased Penetration of Managed Care

109

(1)

Risk Reduction/Health Promotion

109

(1)

Conclusion

110

(1)

References

110

(1)

Index

111

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