Gadd, Holly

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Medical coding and billing errors are avoidable problems that have afflicted practitioners for decades. Correct coding and billing are required for reimbursement of healthcare services. Fraud, waste and abuse increase healthcare costs, reduce the quality of care provided and directly impact costs to patients. This pilot study was intended to evaluate the impact of an educational webinar on medical billing and coding, fraud, waste and abuse on nurse practitioner (NP) knowledge using a pretest posttest design. Mean scores increased from 58.4% to 76.4%. Test reliability was low at 0.477 (pretest) and 0.142 (posttest) with two questions that were unable to be used. Following the educational webinar, 19 participants felt the educational webinar contributed to their overall knowledge, while 5 participants did not feel the webinar added to higher learning. Ten participants declared neutrality in regard to educational benefit. Although the pilot showed a statistically significant increase in test scores reflecting short term knowledge, revisions in the webinar, test, and data collection process are recommended.

Keywords: fraud, waste, abuse, medical coding, medical billing, reimbursement, False Claims Act, Anti-kickback Statute, Stark Law, provider, Medicare, nurse practitioner, legal issues, advanced practitioner, clinician