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Electronic Health Record (EHR) and Nurse Practitioner Billing: Implementing Interoperability 

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Private practice EHR selection and implementation can be a significant challenge for the NP entrepreneur. Not only does EHR documentation play a critical role in tracking and improving patient health, but it also has a direct impact on how to bill insurance efficiently and accurately. Reimbursement issues for nurse practitioners can often be traced back to incomplete documentation, resulting in denied claims, decreased profitability, and reduced patient satisfaction.  

With electronic health records being critical to the operations of an NP private practice, how can you best leverage interoperability between your technology systems to improve patient and practice outcomes? 

Impact of EHR on Nursing Practice 

In the past, paper charts may have felt like an efficient way to document and deliver attentive patient care; however, the now dated documentation process leaves much to be desired. For one, the lack of standardization and comparability of patient data makes monitoring and reporting on your patient panel’s health and wellness significantly more difficult. Additionally, paper charting complicates organization and leaves you vulnerable to misplacing files, potential theft, and loss of documentation through potential disasters like fire or water damage.  

When properly implemented and customized to your NP business needs, the positive impacts of EHR on nursing practice are as follows: 

  • Ability to provide attentive care, utilizing workflows and drop-down lists where possible, and text fields when necessary 
  • Improved communication with patients, providers, and payers – leading to better care coordination and improved patient outcomes  
  • Decreased documentation time, especially time spent updating patient records after hours 
  • Ability to see patients using telehealth, documenting online visits within the system 
  • Simplified and more efficient documentation in your electronic health record and nurse practitioner billing, leading to expedited and improved reimbursement 
  • Improved internal administrative and operations processes that enable better leadership of your care team and staff 

How to Bill Insurance as a NP Business Owner 

The first steps in billing begin with your insurance credentialing process and payer contracting negotiations. Both commercial and federal payers have unique sets of rules to navigate in order to enroll your practice in their reimbursement programs. The processes and requirements of private insurance reimbursement for nurse practitioners vary depending on the payer, your specialty, and your state. When considering which payers to contract with and how to bill insurance, evaluate the needs and payer mix of your target population.  

Documentation in your electronic health record and nurse practitioner billing are closely tied. Once your NP business is enrolled with payers, you should familiarize yourself with their billing and coding requirements. Though these contracts may be difficult to understand, like any legal agreement they should be thoroughly reviewed before signing. Review your payer contracts to understand the time frame in which the payers are required to reimburse your claim and if there are services that require pre-authorization. Ask a business partner, trusted advisor, colleague, or even a family member to review with you as well, leaning on health plans for further explanation when necessary.  

Your private practice EHR should be customized in a way that simplifies access to common billing codes and provides search functionality to find more obscure additional codes. To minimize delays in reimbursement, submit claims shortly after the service has been delivered, ideally within 24 hours of treatment.  

Reimbursement Issues for Nurse Practitioners 

With the complexity of insurance credentialing for nurse practitioners, variability in private insurance reimbursement for nurse practitioners – and complications with interoperability between electronic health records and nurse practitioner billing – it is no surprise that reimbursement issues for nurse practitioners can arise.   

As an NP business owner, delayed, rejected, or denied claims can be devastating. Additionally, certain billing errors may even lead to legal issues for nurse practitioners. How can you work towards avoiding these reimbursement issues?  

Start by looking for simple errors such as: 

  • Inaccurate or incomplete patient information such as name, insurance ID number, or date of birth 
  • Inaccurate or incomplete provider information such as provider name, address, or contact information 
  • Incorrect, mismatched, duplicate or missing codes  

To avoid these simple mistakes, or more significant errors like undercoding or upcoding, NP private practice owners may want to consider outsourcing their billing. This often can be more cost-effective than hiring in-house billing staff and adds an additional layer of security and scrutiny, making errors less common. 

Implementing Interoperability  

Interoperability between systems simplifies processes for providers, staff, payers and patients alike. Connecting technology like electronic health records, telehealth, and online bill payment makes it easier to collect reimbursement, co-pays, and other payments, accelerating your revenue cycle and profitability.  

As an independent practice owner, you will likely consider an assortment of vendors for business requirements such as credentialing, contracting, EHR, practice marketing, telehealth, billing and more. While outsourcing particular elements of operations can make things easier, more cost-effective, and efficient, managing too many vendors can complicate interoperability. Often, independent vendors are hesitant to connect external systems to their technology or share data externally.  

Working with vendors that offer a full suite of multiple solutions is an effective way to minimize data silos and interoperability complications – not to mention the ease of management of one vendor as opposed to five or more for you as a business owner.  

NP Advantage Can Help 

A partnership with the NP Advantage team provides nurse practitioner entrepreneurs with a customized, telehealth-enabled, state-of-the-art EHR system. Our team creates custom templates, workflows, and drop-downs to simplify documentation that optimizes patient wellness and reimbursement. We also assist NPs in outsourcing their billing so that they can focus their attention on patient care. Along with electronic health records and nurse practitioner billing, our solution suite includes practice marketing, healthcare analytics, and operations consulting, providing guidance on next steps to drive business success.  

Let’s Improve Patient Care Together

Checklists for Independent Nurse Practitioners

With over 25 years of experience supporting practice launch and growth, we developed the following checklists to guide nurse practitioners. Click the button below to read more.