American Nurses Credentialing Center (ANCC) is the world’s largest and most prestigious nurse credentialing organization, and is a subsidiary of the American Nurses Association (ANA). ANCC certification exams validate nurses skills, knowledge, and abilities and more than 80,000 advanced practice nurses are currently certified by ANCC. Before nurses can sit for a certification examination, they must demonstrate that they hold active RN licenses, have the appropriate education, and, for all but nurse practitioners and clinical nurse specialists, have experience in the specialty field. Those who have met the eligibility requirements can then register to take the certification examination. Each exam is designed by certified nurses in the specialty under the guidance of a professional psychometrician who ensures that all tests are psychometrically sound and legally defensible. Tests are based on the scope and standards of practice approved by the American Nurses Association Congress of Nursing Practice and Economics. The paper-and-pencil tests generally are given twice each year at many locations around the United States and at military installations abroad. Most Clinical Nurse Specialist and all Nurse Practitioner, Informatics Nursing, Cardiac/Vascular, and Gerontological examinations can be taken at the candidate’s convenience because they are computer-based.
The Magnet Recognition Program was created by the American Nurses Credentialing Center (ANCC) to recognize healthcare organizations that provide nursing excellence. Institutions designated as “magnet” hospitals are recognized for their ability to attract and retain professional nurses.
Health Reimbursement Accounts or Health Reimbursement Arrangements (HRAs) are Internal Revenue Service (IRS)-sanctioned programs that allow an employer to set aside funds to reimburse medical expenses paid by participating employees. Using an HRA yields “tax advantages to offset health care costs” for both employees as well as an employer. (definition courtesy of Wikipedia)
HIPAA Law The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes provisions related to insurance, privacy, security, transactions and code sets.
The Administrative Simplification Compliance Act (ASCA) amended the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and required that all claims submitted to Medicare on October 16, 2003 and beyond be done so electronically except for certain circumstances.
Patient Protection and Affordable Care Act (ACA) Administrative Simplification provisions build upon the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with new and expanded provisions, including a requirement to adopt operating rules for each of the HIPAA transactions; a unique, standard Health Plan Identifier; and standards for electronic funds transfer (EFT) and electronic health care claims attachments. The Affordable Care Act requires that health plans certify their compliance with the standards and operating rules, and provides penalties for noncompliance.
Medicare and Medicaid use HCPCS (Healthcare Common Procedure Coding System) which is based on the American Medical Association’s CPT system. Codes are globally grouped into Level I and Level II:
- Level I codes include the 5-digit numeric CPT (Current Procedural Terminology) codes. These were developed by the American Medical Association (AMA) in 1966 and remain proprietary to the AMA. The codes are updated in October and become effective as of the next calendar year. They are available as a printed manual or as an electronic file.
- Level II codes are national codes developed by the Centers for Medicare and Medicaid Services (CMS) to describe medical services and supplies not covered in the CPT. They consist of alphabetic characters (A through V) and four digits.
BTW, HCPCS is pronounced “hick-picks.”
An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number (TIN), and is used to identify a business entity.
An HSA is a medical savings account that allows individuals and employers with high-deductible insurance policies to contribute tax free to an account to pay current or future qualified medical expenses.
Hospitalists are physicians who work full-time in the hospital setting. Hospitalists typically work long shifts, often 12 hours at a time and may work 5 to 10 days in a row, taking 5 to 10 days off in rotation. Hospitalists may be employed by the hospitals or by private groups, and are responsible for admitting patients, caring for them during their inpatient stay and discharging them. They may care for patients on behalf of community physicians, or may see only patients who do not have a primary care physician.
Disenrollment is the process of rescinding insurance coverage to individuals or groups.
Economies of scale is a term used by economists to refer to the situation in which the cost of producing an additional unit of output (i.e., the marginal cost) of a product (i.e., a good or service) decreases as the volume of output (i.e., the scale of production) increases.
In the medical practice, economies of scale are related to the group practice model of more than two physicians working together. A single physician needs and will pay for a receptionist for the practice, but the receptionist may not have enough work to do to fill the time for a solo physician. In a practice of three physicians, however, the receptionist is kept busy and each physician needs only to pay 1/3 of the cost. Additionally, group practices are able to negotiate discounts on supplies due to volume and may also be able to negotiate better rates from payers. They may also be able to raise capital to invest in ancillaries like a specimen laboratory, imaging, or other type of testing lab.
Economies of scale can also determine the optimum size for a medical practice and at what point an increase in the number of physicians actually causes “diseconomies of scale” due to complexity of the organization.
