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Discussion: Reimbursement Issues for Nurse Practitioners Understanding the complex process of accurate coding and billing is...

Discussion: Reimbursement Issues for Nurse Practitioners

Understanding the complex process of accurate coding and billing is essential to a sustainable practice. As NPs, we are ultimately responsible for ensuring all coding and billing is accurate for each patient seen. For this Discussion, you will search the health care literature and summarize a peer-reviewed journal article published within the last five years.

To prepare:

Select one of the following topics:

Applying for Medicare and Medicaid Provider Numbers

Application process for National Provider Identifier Number

Incident to billing

Coding-Evaluation & Management

Fraudulent billing

Billing Self-Pay patients

Managed Care Organizations

Conduct a search and select a peer-reviewed journal article published within the last five years related to the topic you selected.

Post a brief summary of the article you selected. Include the key reimbursement issue addressed and how they would impact the NP in a collaborative practice versus and independent practice. Discuss an ethical or legal implication(s) associated with your article.

Solutions

Expert Solution

Applying for Medicare and Medicaid provider number.

The national association of pediatric nurse practitioner recently revised it's position statement on the status of reimbursement policies of public and third party payers for health care services provided by the nurse practitioner. The statement was published in may/june 2016 issue of the journal for pediatric health.

Under current payment model. Medicare reimbursement, state medicaid programs and third party payers, nurse practitioner are reimbursed only 85% of the rate paid to physicians for providing the exact same service. This biased inequality payment system sometimes leads to questionable provider billing. Even worse, nurse practitioner outcome data are almost always obscured because their service are hidden under higher paid physicians.

The billing,coding,electronic medical records and culture of healthcare were substantially different than today, there are no realistic barriers that prevent the health care system from supporting reimbursement parity.

Nurse practitioner requires the establishment of suitable reimbursement mechanisms with in the general context. Under the current medicare arrangements access to diagnostic tests and reimbursement for services are prohibited unless initiated by a medical practitioner.


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