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PubMedDate not supplied

Understanding diagnostic related groups (DRGs) and inpatient hospital reimbursement.

Knowing insurance plan regulations and complying precisely with requirements is critical for hospital reimbursement of care provided. Diagnostic related groups provide guidelines widely used in the United States to determine hospital reimbursement by Medicare, Medicaid, and many insurance providers. Because hospitals are the largest employers of nurses, nurses have a responsibility and interest in contributing to the stability of their hospital's financial status to protect incomes and job security. This article provides an overview of diagnostic related groups and demonstrates how nurses can contribute to more accurate documentation outcomes that determine hospital reimbursement.

Cost Control↗
PubMed1993

Therapeutic drug monitoring in ambulatory care.

There is a growing emphasis on developing ambulatory care services in an attempt to minimize healthcare costs through preventive medicine and outpatient therapeutic management. This creates an environment that can greatly benefit from a pharmacist-managed ambulatory TDM service. The implementation of a pharmacist-managed TDM service can improve patient care, contain the cost of healthcare, and enhance the education of pharmacy/medical students and physicians. The opportunity exists for further development of clinical pharmacy services to positively influence patient care in the ambulatory care setting. This development, however, may be hindered by inadequate reimbursement for services and lack of documentation to support the beneficial impact of clinical pharmacy services on patient outcome. Methods of documenting clinical pharmacists' interventions and outcome must be developed in order to obtain reimbursement for these services.

Ambulatory Care↗
PubMed2003

Interest groups and state Medicaid drug programs.

A simultaneous equations model is estimated to analyze the interaction between state Medicaid pharmaceutical drug reimbursement rates, drug recipients per capita, and expenditures per drug recipient. Interest groups are shown to have a strong positive impact on pharmacy reimbursement rates, which, in turn, have an impact on pharmacy participation rates and drug utilization and expenditure patterns. Finally, a strong inverse relationship exists between expenditures per recipient and program size. The results verify the existence of substantial variation in state Medicaid programs and point to potentially growing disparities as a result of current policies.

Decision Making, Organizational↗
PubMed2000

Reimbursement for acute care nurse practitioner services.

Until the passage of the Balanced Budget Act of 1997, acute care nurse practitioners could not be directly reimbursed for inpatient services provided to Medicare patients. With the enactment of this legislation, acute care nurse practitioners may now be directly compensated for care provided. The historical and contextual issues that surround reimbursement for nursing and advanced practice nursing services are reviewed to serve as a foundation for understanding the current Medicare reimbursement regulations. The implications of the Balanced Budget Act of 1997 for acute care nurse practitioners and their professional colleagues are critically examined. The language of the Balanced Budget Act of 1997 and the subsequent rules and regulations issued by the Health Care Financing Administration are reviewed with specific focus on implications for acute care nurse practitioners. The opportunities for reimbursement for services provided by acute care nurse practitioners are more extensive than ever before. Acute care nurse practitioners and their physician colleagues will be wise to become fully conversant with the changes in Medicare reimbursement regulations.

Aged↗
PubMed1998

Accreditation: year 2000 compatible.

Procedure pricing will not provide the competitive advantage in 2000. The ambulatory care organization must demonstrate its commitment to quality care and outcomes. Only through achieving an accreditation status can an organization truly demonstrate their commitment to their customers.

Accreditation↗
PubMed2005

I am a physician.

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Allied Health Personnel↗