Reimbursement for NP Services
Order Instructions:
SECTION A (1.5 pages minimum)
Reimbursement for NP Services
Reimbursement processes and rates for services provided by NPs vary between funding sources. Differentiate between public, private and managed health care plans. Research the application process for NPs to join the panels for reimbursement and the rates of reimbursement for services provided by NPs. Share with your colleagues which panel(s) you researched and what you learned.
Include a reference list at the end of this section 4 minimum.
SECTION B (1.5 pages minimum)
Healthcare Reform and the NP
Health care reform has prompted numerous debates in regard to reimbursements for providers, such as NPs, Physician Assistants (PAs) and MDs. What are the arguments, data, and rationale used by proponents and opponents of healthcare reform? What is your perspective on the implications of healthcare reform in regard to the role of the NP?
Also, in less than 300 words assess how regulatory, legal, and legislative issues impact advanced practice nurses and discuss how this plays into healthcare reform.
Include a reference list at the end of this section 4 minimum.
Resources
Advanced Practice Nursing: Emphasizing Common Roles
• Chapter 7, 13
Please review the following web resources:
American College of Nurse Practitioners
Centers for Medicare & Medicaid Services
HealthCare.gov
SAMPLE ANSWER
SECTION A: Reimbursement for NP Services
Reimbursements for the services provided by nurse practitioners (NP) constitute a significant part of the health care programs offered in the United States of America and there are considerable variations in the extent of reimbursement rates according to the processes adopted as well as between funding sources (Safriet, 1992). For example, there a various public, private and managed health care plans in the US and there are relative variations between them on basis of the reimbursement rates as well as adopted reimbursement process. In particular, the major health care plans include Medicare, Medicaid as well as commercial indemnity insurers, health maintenance organizations and/or commercial managed care organizations (MCOs) and finally schools or businesses that want provision of health services for their student or employees respectively. Each of the above mentioned health care plans have varied rules and regulations on reimbursement process and rates for the services provided by NPs (Safriet, 1992).
The particular differences that exist between the above mentioned health care programs are in form of management, ownership as well as reimbursement rates as well as reimbursement process. For example, both Medicare and Medicaid health care programs are managed by the government to provide health insurance services to its citizens who meet threshold requirements for inclusion (Stanley, 2010). All the latter health care programs are privately managed or managed by non profit making organizations. Moreover, these health care programs are differently owned where both Medicare and Medicaid are owned by the government while the rest health care programs are either privately managed or managed by non profit making organizations.
Furthermore, in order for the NPs to join the panels for reimbursement the application process also vary considerably as well as the reimbursement rates for the health care services that the NPs provide (Stanley, 2010). In particular, the for an NP to join the Medicare reimbursement panel, the must be holders of state licenses as an NP while at the same time an holder of a certification as an NP by a nationally recognized certifying professional body. Some of the nationally recognized professional bodies for certifying NPs include National Certification Corporation, Americans Nurses Crediting Center, Critical Care Certification Corporation, as well as American Academy of Nurse Practitioners (Stanley, 2010). Moreover, since January 1, 2003 individuals who intend to apply for Medicare reimbursement panel must also be in possession of a master’s degree from a recognized institution of higher learning. Upon meeting the above mentioned requirements an individual NP can apply to join Medicare reimbursement panel (HealthCare.gov).
According to Medicare the reimbursement rates to the services provided by NPs, the NPs are paid 80 per cent of the 85 per cent of the rate of physicians Fee Schedule for any medical procedure where an NP participates since in Medicare an NP must always offer his/her services in conjunction with a physician to qualify for reimbursement (Medicare & Medicaid Services).
References
American College of Nurse Practitioners, Retrieved from: http://www.discovernursing.com/about-us
Centers for Medicare & Medicaid Services, Retrieved from: http://www.cms.gov/
HealthCare.gov, Retrieved from: https://www.healthcare.gov/
Safriet, B.J., (1992). Health care dollars and regulatory sense: The role of advanced practice nursing. Yale Journal of Regulation, 9(2), 417-488.
Stanley, J.M. (2010). Advanced Practice Nursing: Emphasizing Common Roles, (3rd ed.). New York, NY: F.A. Davis Company.
SECTION B: Healthcare Reform and the NP
Reimbursements for health care providers such as NPs, MDs and Physician Assistants (PA) have prompted numerous debates with regards to health care reform. For instance, over the last two decades key issues that have influence health care system in the United States and in particular with regards to reimbursement for the services provided by health care providers. The key debates have revolved around improvements of health care access while containing the costs and maintaining quality for the health care services. However, the direction of this debate has always been changing in direction on basis of newly upcoming issues (Griner, 1995). For example, the rapid increases of health care costs in the 1980s together with global recessions of the early 1990s brought another new issue regarding to making sure that security of health care benefits that accrue from the health care programs are sustained. Based on this premise, the main debate with regards to reimbursements has not only revolved around the rates or process, but around the cost of health care services access (Stanley, 2010).
The arguments by proponents have been that the cost of health care access should be maintained as low as possible even if it means reducing the reimbursements rates, but on basis of a stringently controlled procedure. This includes devising a procedure through which NPs, MDs and Physician Assistants (PA) reimbursement rates could be maintained as affordable as possible in order to make them easily accessible while ensuring quality is not compromised (Stanley, 2010). Since a considerable number reimbursements are done by public health care programs such as Medicare and Medicaid, proponent of reduction in reimbursement rates argue that this would reduce the amount of money the government uses on this programs meaning that if the same budget is maintained the more people would access quality health care affordably courtesy of these public health care programs. On the other hand, the opponents of this debate argue that it would not only compromise with the quality of health care services but also it will significantly reduce the motivation of health care providers such as NPs, MDs and Physician Assistants (PA) as a result of low reimbursement rates (Stanley, 2010). My perspective on the implications of healthcare reform in regard to the role of the NP is that the same reimbursement rates should be maintained, but the government should increase budgetary allocations for these programs to ensure wider access (Stanley, 2010).
Regulatory, legal, and legislative issues have the potential o significantly impact advanced practice nurses into healthcare reform (Safriet, 1992). For instance, regulatory issues help to ensure that the threshold requirements are met by advanced practice nurses in order to guarantee quality. Moreover, the legal and legislative issues impact advanced practice nurses by making sure the necessary laws and rules are formulated to ensure healthcare is stringently controlled with regards to intended reforms (Stanley, 2010).
References
American College of Nurse Practitioners, Retrieved from: http://www.discovernursing.com/about-us
Centers for Medicare & Medicaid Services, Retrieved from: http://www.cms.gov/
Griner, P.F. (1995). The work force for health: Response. 20/20 Vision: Health in the Twenty-first Century. Washington, DC: Institute of Medicine, 102-103.
Safriet, B.J., (1992). Health care dollars and regulatory sense: The role of advanced practice nursing. Yale Journal of Regulation, 9(2), 417-488.
Stanley, J.M. (2010). Advanced Practice Nursing: Emphasizing Common Roles, (3rd ed.). New York, NY: F.A. Davis Company.
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