Chapter 6: Health Care Fiscal Management
Identification: AMBP020v2019c06
Expiration Date: December 31, 2023
Credits (Post Test and/or Evaluation Required)
Available until 12/31/2023
- 1.40 - CH
Description
Continuing Education Instructions and Disclosure Information:
- Contact hours available until 12/31/2023.
Requirements for Successful Completion:
- Complete the learning activity in its entirety and complete the online CNE evaluation. You will be able to print your CNE certificate at any time after you complete the evaluation.
Faculty, Planners, and Authors Conflict of Interest Disclosure:
- There are no disclosures to declare
Commercial Support and Sponsorship:
- No commercial support or sponsorship declared
Accreditation Statement:
- This educational activity is jointly provided by Anthony J. Jannetti, Inc. (AJJ) and AAACN.
- Anthony J. Jannetti, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
- AAACN is a provider approved by the California Board of Registered Nursing, provider number CEP 5366.
Learning Outcome:
- After completing this learning activity, the learner will be able to demonstrate knowledge of health care finance including commonly used financial terms, payment systems, basic budgeting principles, and the nurse leader's role in evolving financial models of care.
Learning Engagement Activity:
- This chapter identifies several examples in which the actions of nurses and nurse leaders impact reimbursement for an ambulatory clinic. Can you identify at least three?
Note - only CE Evaluations are available online.
Author(s):
- Author Heather Healy, MSN, RN, FNP-BC, NEA-BC, PMP
Credits Available
- 1.40 - CH
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Sarah Sylvia
1/26/23 10:38 pm
Nurses and Nurse managers effect reimbursement in many different ways. The nurses in my infusion center are responsible for charging patients appropriately for services. If a charge is missed or done incorrectly then the hospital may not be reimbursed for services correctly. The care a patient receives in the office is directly linked to some reimbursement like with a PPO or an HMO plan. If something goes wrong with the patient and the care costs more then agreed upon this may mean a lose in revenue for the office. With an HMO if certain quality standards of care are not met then there is a risk for the ambulatory office to not receive reimbursement. It is the responsibly of the office and its providers to deliver that quality care that meets standards. Ambulatory nurses are responsible for managing the outpatient appropriately. Assessing and recommending to the provider appropriate care based on their knowledge, experience, and overall encounter with the patient is vital to minimizing cost. If a patient gets an unnecessary or duplicate test or inappropriate admission this leads to higher costs that may not need to be accrued.
Jamie Hillsberry
4/25/23 10:49 am
At the infusion center I work for the nurses are responsible for placing the correct charges into the patient's chart. I feel this is extremely important because each infusion charge is different, a patient can be charged for a "Chemo infusion" or a "Venipuncture" or if a patient is having their "PICC line removed." Additional charges could also be for a certain injection, subcutaneously or intramuscular. I also know while working in the hospital nurses are responsible for discharging their patients in a timely manner because this can effect certain charges and reimbursement costs towards the hospital and patient. And the most important of all would be to make sure no medication errors occur or any safety issues which could be very costly for a hospital.
Anna Zmujdzin
7/6/19 7:16 am
I have enjoy reading this section because it clearly defines the role RN has in outpatient setting. We are not only bedside support but also provide bigger picture of the management of the cost and investments. Non clinical staff may have no clear understanding of what product to use or what CPT code to use to charge for procedures or injections. For example, we charge for vaccine but the order do not include injection code.