Nursing Case Management - Essay Example

"Nursing Case Management" is a perfect example of a paper on care.  Nurse practitioners have an important role in health care today; this is why the subject is so relevant to my future specialty practice. According to Cohen and Cesta (2005, p. 212), “many managed care organizations now depend on physician assistants and nurse practitioners to provide services in the area of primary care”.

Reimbursement and Billing Problems: According to the Balanced Budget Act of 1997, CNS should be reimbursed through Medicare when undertaking physicians' work. Most states have a coding and billing system to, make sure that a CNS receives its reimbursements, but some people have been denied reimbursement even after going through service with a physician. To give an example, CNS will not be reimbursed if a physician is visited by a repeat same-day patient. The process of claiming and collecting Medicare reimbursements is quite often lengthy and complicated. To combat this problem, CNs have taken on a different work schedule to another physician; if the client needs to refer to the physician, then this can be done.

Barriers to Title Protection: Title protection only permits fully qualified nurses to practice. Most states do not have title protection for clinical nurse specialists. The problem here is that they face the challenge of not being considered advanced nurses. Up until April of 2010, 29 states had given legal protection to the title of "nurse;" however, according to the American Nurses Association, only Florida, Delaware, and Arkansas specifically protected the title of a clinical nurse specialist. The first step is to contact the local state board of nursing. Try to become a member of the board or an advisory committee. If you are unable to become a board member, then the next best alternative is to regularly meet with board members and educate them about the role of CNS. Finally, teach, explain, demonstrate, and repeat the aforementioned as required.

2. Discuss how you see YOUR future practice as a CNS influencing health outcomes in each of the 3 CNS spheres of influence (patients & families; nurses and nursing personnel; the health care system or organization).

It would be wise to include the patients and their families in the process of managed care and case management. According to Newell (1996. p. 207), “once the case manager has established a level of communication with the patient and family, this enables him or her to know the implications of the illness and patient and family-defined needs and wants; thus, an appropriate plan can be constructed.” As nursing to nursing personal, CNS should encourage staff to attend and participate in the seminar and evidence-based practices. For the healthcare system or organization, there is some research that is available to nurses on the American Nurses Association website. One warning is that you must join the organization to be able to have access. On the positive side, this does allow for a wealth of information to be at the disposal of the nurse. It makes sense that nurses who are more interested in pursuing an academic degree in the field should be encouraged to join ANA for one simple reason—hopefully, it will allow for nurses to be able to gain more access to the materials that will help them complete research in their field of specialty, most definitely. There are other specialty organizations, such as the NACNS and AACN that represent advanced practice nurses.

5. 5. What strengths do you bring to your future role as a CNS?

As a current graduate student in the CNS program, I believe that CNS must be given the right to practice autonomously in order to meet the demands of the nation under the new Healthcare Reform Act. I believe that the nation would substantially benefit from the utilization of CNS in primary care and a preventative services role. We must break down the barriers and misinformation that the public currently holds about CNS care managing. We must work to strengthen the relationships between CNS and MDs so that we will be able to work together and not against each other. CNS will also be needed to coordinate multifaceted patient care among healthcare providers.

 

 

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