What would be a response to this?

What would be a response to this? A third-party payer often determines reimbursement policies. Third party payers fall into seven categories that include Medicare, Medicaid, indemnity insurance companies, managed care organizations, workman’s compensation, Veterans Administration, and auto liability (Dunphy et al., 2019). Each payer source has its own policies and schedules, and it is the responsibility of the nurse practitioner to know these policies to ensure proper and full payment. All the third-party payers use guidelines provided by the CMS and they make sure that the beneficiaries in these programs can obtain high quality health care (Dunphy et al., 2019). Staying up to date on these policies is crucial to maximizing payment from these payers. A new patient is one who has not received any professional services from the physician or provider or any other provider of the same specialty who belongs to the same group practice within the past three years (Cox, 2022). An established patient has received professional services from the provider or another provider in the same group and the same specialty within the prior three years (Cox, 2022). This also includes any evaluation and management service or other face to face service. New patient visits require more work than established patient visits at the same level and that is why this is reflected in the coding requirements as well as the reimbursement to the provider (Cox, 2022). There have been many changes recently to the evaluation and management codes. Some of these changes include code 99201which was used for a level one new patient was deleted as it was rarely used (Guide to 2021 Evaluation & Management Changes, 2020). Another big change was that the history and examination was removed as key components for selecting the level of evaluation and management service (Guide to 2021 Evaluation & Management Changes, 2020). History and examination were both used to select the appropriate E/M service and will still be performed by the provider to report proper CPT codes (Guide to 2021 Evaluation & Management Changes, 2020). One of the biggest changes came with the option for providers to choose time over medical decision-making elements for their reimbursement. Time intervals also changed giving providers some latitude for billing. There are multiple other changes as well that will be discussed later in my next assignment. Unfortunately, I cannot share anything regarding billing as I start my clinicals middle of next week. I do know that the provider of the office stated that the biggest issue that he has with his providers is correctly coding their visits for proper reimbursement. I am looking forward to jumping in and learning more through my clinicals. SCIENCE HEALTH SCIENCE NURSING NRP 555

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