Primary Care Provider's Guide to Compensation and Quality: How to Get Paid and Not Get Sued / Edition 1

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The Primary Care Provider's Guide to Compensation and Quality, Second Edition provides physicians, nurse practitioners, and physicians assistants with the basics they need for reimbursement; improving quality care; avoiding malpractice; and excelling in quality audits. The book is written in accessible language and provides practical advice on current trends such as growing patient enrollment in managed care health plans, performance evaluation of PCPs by outside agencies, and the dramatic increase in the auditing of billing practices.

The book contains black-and-white illustrations.

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Editorial Reviews

Provides practical advice for primary care providers about major trends that have emerged over the past five years, such as growing patient enrollment in managed care health plans, performance evaluations by outside agencies, and the dramatic increase in billing audits. Linking quality and reimbursement issues, Buppert combines her experience as a nurse practitioner with her legal practice to discuss avoiding fraud and abuse in billing, surviving audits, monitoring and improving medical outcomes, avoiding malpractice suits, submitting clean claims, minimizing denied claims, preventing requests for additional information, and speeding claims processing. The included disk includes checklist progress note forms for the 20 most common primary care diagnoses and checklists of 20 primary care tasks for HEDIS measurement. Wire spiral binding. Annotation c. Book News, Inc., Portland, OR (
From The Critics
Reviewer: Nancy A. Johnson, R.N., C., M.S.N., W.H.N.P.(Texas Tech University Health Sciences Center)
Description: This book contains an almost overwhelming set of guidelines for primary care providers to accomplish the difficult task of keeping up with the rules and regulations applicable to healthcare services in today's environment. The uniqueness of this book lurks in the appendix with the checklist documentation forms section. This second edition follows the original book published in 2000.
Purpose: The purpose is to assist primary care providers with needed information in order to pass quality audits and payment audits. The objectives cover issues which provide worthwhile steps for coding, billing, managing contracts, excelling in managed care audits, improving medical outcomes, avoiding malpractice legal pitfalls, and saving time with performance measures. The author meets the objectives with the topics covered and especially the chapter 13 forms.
Audience: This book is written for students, residents, and practitioners in primary care practices. The author clearly states the book is targeted to primary care providers so they can breeze through quality audits and payment audits. The author is a nurse practitioner and an attorney who specializes in legal issues affecting healthcare providers.
Features: The book presents benchmark criteria, outcome measures, tracking information, malpractice issues, reimbursement methodologies for billing, and maximizing payments for primary care. The appendix is loaded with documentation forms that address consistent guidelines for users throughout the United States. The unique feature of this book is the use of consistent guidelines that can be applied as a uniform system of assessment across the nation. The use of the forms would reduce legal pitfalls in healthcare delivery. Lack of color and illustrations are the major shortcomings of the book.
Assessment: Overall, this book offers useful and informative guidelines for primary care providers. It is truly an exceptional book for healthcare providers, and one of a kind written by a nurse practitioner attorney whose judgment is trustworthy. Because of frequent legislative changes that result in legal pitfalls and inadequate reimbursement, this second edition is justified in replacing the 2000 publication.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780763725037
  • Publisher: Aspen Law & Business
  • Publication date: 3/14/2003
  • Series: Long Term Care Series
  • Edition description: Older Edition
  • Edition number: 1
  • Pages: 412
  • Product dimensions: 8.30 (w) x 10.80 (h) x 0.90 (d)

Table of Contents

Ch. 1 Measuring performance in primary care 1
Ch. 2 Systems for meeting benchmarks for screening and health maintenance 21
Ch. 3 Measuring outcomes in primary care 123
Ch. 4 Systems for measuring outcomes at the practice level 129
Ch. 5 Systems for tracking functional status 139
Ch. 6 Systems for measuring and tracking patient satisfaction 149
Ch. 7 Malpractice : the ultimate failure in quality 211
Ch. 8 Systems for avoiding malpractice 223
Ch. 9 Reimbursement for primary care 245
Ch. 10 What is fraud and abuse in billing? 255
Ch. 11 Systems for complying with requirements of Medicare and other payers 269
Ch. 12 How to contract with managed care organizations 357
Ch. 13 How to maximize reimbursement 371
App. A Checklist documentation forms 377
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