Advocacy Role Paper

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Submitted By desicsmith
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Pages 4
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. CRITICAL ANALYSIS OF OFFICIALS VIEW ON ISSUE 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…...

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