The Significance of APRN Regulatory and Coding Compliance

This report delves into the critical aspects of regulatory and coding compliance for Advanced Practice Registered Nurses (APRNs). It clarifies the significance of these compliances in practice, detailing how they facilitate accurate billing, adherence to Medicare guidelines, and identification of relevant resources. The report further explores the comparison of coding compliance issues under California and federal regulations, highlighting implications of the 60-day rule and the role of federal judges in prosecuting healthcare fraud. It then examines the legal implications of failing to adhere to the standard of care, including negligence and malpractice, and elucidates the five key elements of malpractice: duty, breach, injury, deviation from the accepted standard of care, and damage. Finally, the report compares different malpractice policy options, including claims-made, occurrence, and modified occurrence policies, emphasizing the differences based on coverage dates and premium structures. The report uses several references to support the findings.

Regulatory and Coding compliance
Student’s Name
Institution
Date

what regulatory and coding
compliance for APRNs means to
my practice
. In my practice, they enable me as an APRN to identify the important Medicare
documentation required to bill for the initial, the subsequent and the CPT codes
needed for annual assessments.
They enable me to identify the key components for meeting the medical necessity
criteria under the guidelines of Medicare.
They help me identify the Medicare and the Medicaid services and other websites
that I can find information to submit bills as required . (Cross & (McWay, 2016).

what regulatory and coding compliance for
APRNs means to my practice continuation
 It enables the nursing team identify in a correct manner the common
procedural Technology and the effective codes of service for the nursing
facilities, domiciliary, for group homes and assisted living . This can help in
offering quality care.
 Through them, it is possible to identify LTC regulations that help in clinical
practices in geriatrics and use them in line with compliance to client’s rights.
 It is possible to highlight the common problems faced by APRNs when in
practice and come up wit the appropriate solutions . This is done after
comparing and contrasting the federal and state regulatory issues facing the
reimbursement in LTC and APRN practice, (Cross & McWay, 2016).

Comparison of coding compliance issues
in California and federal regulations.
Both coding compliance and federal regulations help the hospitals in California
develop internal controls that lead to adherence to all health plans and programs
of the private health sector, the federal government and the state.
Both federal regulations and coding compliance programs are put into
consideration by the OIG in California that help in implementing authority and
exercise an exclusive, permissive authority.
A criterion is used to implement permissive authority, where entities and
individuals who comply to coding and federal regulations are excluded from
permissive authority, (Becker, 2012).

Comparison of coding compliance
issues in California and federal
regulations
 Through compliance to federal regulations and coding, there comes
implications to 60 day rule in California. Through section 6402 rule of
affordable care , all providers, drug plan sponsors, and Medicare advantage
organizations ca report Medicaid overpayments and their reports within the
60 day period. This enables efficacy in medical organizations.
 The federal regulations and code compliance issues help federal judges in
prosecuting ay organization or an individual who performs criminal
violations , such as the federal government’s health care fraud and abuse .
 In sentencing the culprits, judges consults FSGO which rewards hospitals that
comply effectively to coding and federal regulations, (Becker, 2012).

Identify and explain any legal implications that
exist for failure to adhere to a standard of care
 It means that there is negligence in the degree of care by a medical
practitioner. He /she fails to be watchful , attentive, cautious or prudent to the
needs of the patient . This ends in violating the rights of the patient as
stipulated in the rules and regulations of standard of care.
 Standard of care is a guiding principle that directs nurses on what to execute
within their nursing proficiency.
 The legal implications towards the violations include being seen as negligent if
their careless actions /practices led to harm/injury to the patient.
 He/she is indicted because of infringing the standard of practice in negligence
proceedings, Hammaker & Knadig, 2017).

Identify and explain any legal implications that
exist for failure to adhere to a standard of care
 He /she is legally charged with malpractice and rendered responsible to
malpractice lawsuits incase of any unsuitably managed remedy, unexamined
medical equipment or failing to caution the patient about any ills
accompanying the action.
 On regular basis, the medical practitioners have the responsibility of recording
medical assessments of every patient and held responsible when they fail to
assess the health state of the patient.
 (Hammaker & Knadig, 2017).

Identify and explain any legal implications that
exist for failure to adhere to a standard of care
 The health practitioner defends his allegations by using his legal responsibility
insurance. The petitioner may reject the insurance at the end of the day, through their
legal representatives.
 Subsidy programs are also provided in some states as malpractice options when
malpractice cases occurs.
 Other states also utilize the taxes portion of other tax payers exclusive of the field of
medicine as measures in case of legal medical malpractices.

Identify and explain the key
elements of malpractice
There are five key elements of malpractice
This includes duty, breach, injury, deviation from the accepted standard of care
and damage.
In the element of duty, the health practitioner owes the responsibility of care to
the patient. There must be the patient – doctor or health care practitioner – patient
relationship.
The practitioner owes patient for he/she could have granted secure surroundings
to the patient and warned them of any underlying negative implications.
In the breach element, the medical malpractice case is referred to a breach of
duty to the patient. irrespective of the harm the patient went through/experienced,
the medical practitioner owes the patient because he /she is the individual who
was in charge, ("Law 101: The Five Elements of a Medical Malpractice Case,"
2015)

Identify and explain the key
elements of malpractice
 For example, in failure to offer secure surroundings, where he/she didn’t keep away any spiky
equipment for operations that could harm the patient or failed to monitor the surrounding medical
equipment for safety.
 In element of injury, damages/hurt/harm arise as a result of breach. For example failure to handle
equipment properly leading to harm the patient.
 The injury might be physical or emotional such as psychological trauma which come along as a
result of breach of duty.
 In the element of deviation from accepted care standards, there must be prove that the health
practitioner acted in a way contrary to the accepted professional standards. It is also called
causation. The present evidence must be very clear and tangible and satisfies the judges that the
action performed by the nurse led to harm/injury to the patient. If the equipment was kept at the
right place during the operations, it means that the patient could not have been hurt, ("Law 101: The
Five Elements of a Medical Malpractice Case," 2015)

Identify and explain the key
elements of malpractice
 The practitioner in one way or the other failed t do or did something
that another medical practitioner should do or should not have done.
 The element of damage in the medical malpractice brings the basis of
acclaim in a legal case. The negligence of the medical practitioner is
proven by the damage caused.
 The damage may be economic which includes medical bills, inability
to continue working or lost wages.
 There are non - economic damages such as pain and sufferings
caused to a patient as a result of the medical practitioner’s actions.
 Damage may also include the loss of consortium, ("Law 101: The Five
Elements of a Medical Malpractice Case," 2015)

Compare the differences in
malpractice policy option
 There are different definitions of malpractice by every state. In
general, there are two primary malpractice policy options.
 These include the claims made policy option , modified
occurrence policies and the occurrence policy option.
 The differences in these three policy options is based on dates.
 In these three, money versus simplicity is the key issue.