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An RN first assistant's guide to private practice - registered nurse

AORN Journal, April, 2003 by Sheila Hughes

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Patient information. Registered nurse first assistants should keep some patient information for legal, insurance, and billing reasons; however, with the passage of the Health Insurance Portability and Accountability Act, protecting patients' privacy has become a big issue. Self-employed RNFAs must have knowledge of and comply with current, relevant legislation regarding privacy. They also must have the patient sign a release of information form before releasing patient information to the insurance company for reimbursement if this form is not on file in the surgeon's office. Information requested on the form includes service providers, patient, time frame, information to be released, purpose of disclosure, dates, and signatures. (21)

More Articles of Interest: State laws requiring RN first assistant reimbursement; Registered nurse first assistant: An expanded perioperative role; Registered nurse first assistant competencies; Planning for and positioning a solo RN first assistant practice; The RN first assistant as OR concierge

Data in a patient's chart should include medical and nursing diagnoses, the health care facility's admissions/face sheet with biographical data, at least three patient charge/identification labels, date of service, operating/assisting hours, OR in and out time, preoperative and postoperative diagnoses, surgical procedure, and insurance data. Registered nurse first assistants should keep a copy of the surgical report in every patients' file in case a future problem occurs with insurance payment or should they need to appeal an insurance claim. Information on the statute of limitations for claims varies by state and insurance company. Check with the surgeon's billing specialist, the state law, or the insurance company.

Reimbursement. Consideration must be given to current laws and regulations regarding third-party reimbursement at the state and federal level. Currently, RNFAs do not receive Medicare reimbursement; however, AORN has been trying to achieve federal reimbursement since 1987. (22) Current efforts are focused on reimbursement for certified RNFAs. At the state level, nine states have state statutes or regulations that support the reimbursement of RNFAs, including Florida, Georgia, Kentucky, Maine, Minnesota, Rhode Island, Texas, Washington, and West Virginia. (23) Already in 2003, RNFA reimbursement legislation has been introduced in Massachusetts, New Jersey, and Missouri, and it is expected that legislation also will be introduced in Louisiana, New York, and Pennsylvania. To be successful in obtaining reimbursement, nurses and nursing organizations need to demonstrate that the value of the services provided by RNFAs is greater relative to price than services provided by other surgical assistants. (24)

Registered nurse first assistants should establish themselves as providers for third party payers in the region. This can be initiated by contacting insurance companies' provider relations departments for an application. After completion of the application process, a contract will be established with the RNFA for assisting services, and a provider number will be issued. If the insurance company is unfamiliar with RNFAs, follow up with a letter of introduction and discuss the advantages of RNFA service.

Professional liability. Registered nurse first assistants must carry professional liability insurance. Key elements of a liability policy include the insuring agreement, conditions of the contract, and exclusionary clauses.

Health Care Industry

An RN first assistant's guide to private practice - registered nurse

AORN Journal, April, 2003 by Sheila Hughes

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