Advanced practice nurse’s are reimbursed at a lower rate for the same services than physicians by Medicare, Medicaid and other private insurance companies. American medical association sets our scope of practice and regulations and legislation is often influenced by these recommendations. Advanced practice nurses should be consider as equal members of the healthcare provider community and receive equal reimbursement. To make these changes one must develop a plan and advocate for the profession.
Advanced practice nurses are reimbursed at a lower rate, for the same services, than physicians. Medicare reimburses nurse practitioners at 85%, certified nurse midwives at 65 %, and physician assistants at 85% or less of the physician fee. The exception to the reimbursement rate is called the “incident to”. Medicare will reimburse at 100% if billed under a physician provider number. Medicaid pays 75-100% of the physician fee with the exception of some rural areas. Private insurance companies reimbursement to advanced practice nurses policies vary state to state.
In an attempt to find ways to decrease cost, private insurance companies are beginning to follow Medicare’s reimbursement policies. For advanced practice nurses the reimbursement policies vary according to state, company, and licensure, and are not equitable to physician reimbursement. This issue is being buried by the American Medical Association. The Affordable care Act addressed the reimbursement of physicians but APN were not mentioned. 1997 budget act is the last legislation passed that addressed reimbursement for advanced practice nurses.
This act decided that advanced practice nurses are entitled to reimbursement. The legislators in Tennessee at that time voted for or against the act. This issue has not been addressed since then which could say that this is not a priority for the state. It could be the increae cost related to increased reombursement that keeps them from pushing the issue. The affordable Care Act addressed Medicare reimbursement but did not adress APN’s specifically. The govener of Tennessee opted out of taking the money for the state. The federal govt. as to except the cost and reimburse at 100% this could have impacted advanced practice nurses in a positive way. As it stands This issue needs to be addressed with more impact especially after the affordable care and patient protection act. Nurse practitioners will be a solution of the problem and will want to be reimbursed according to care not license. Reimbursement of care provided by advanced practice nurses should equal physicians because they are providing the same service with equal or better outcomes.
In a study done by Laurent, Herman, Reeves, Braspenning, ; Spinbald, “The findings suggest that appropriately trained nurses can produce as high quality care as primary care doctors and achieve as good health outcomes for patients. ” Naylor and Kurtzman found that Nurse Practitioners “out performed physicians in easures of consultation time, patient follow-up and patient satisfaction. “(Naylor ; Kurtzman, 2010). A 2002 report to Congress by the Medicare Payment Advisory Commission, however, was unable to tind reliable data to discern clear ditterences in the two groups’ outcomes and expenses.
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