Explore a current financial or legal dilemma that directly affect the advanced practice nurse. Describe the issue from a pro and con standpoint, identify the various stake holders and mechanisms for resolution that may occur.
APRNs have been dealing with the different scope of practice in state and federal policies, old insurance reimbursement models, and institutional practices. The laws, policies and regulation around billing is especially concerning as they directly affect an APRN’s independence and finances. Unfortunately, the current billing system is complicated and scattered throughout federal and state law, plus vary from payer to payer (Journal of Wound, 2012). As a result, it is necessary to understand billing regulations and …show more content…
This system allows physicians to bill for services performed by other members of the care team, including NPs. This practice allows the billing party to receive 100% of the physician fee schedule for the services rendered vs. if it was billed by and NP using their Medicare Provider ID which would only receive 85% of the physician fee. It's an irrational payment mechanism, but beneficial financially, for this reason, APRNs have accepted this billing practice. With this system, NP services are invisible as an independent care provider. In other words, APRNs are not given credit for being the PCPs of the record thus it's difficult to collect data and evaluate their services (Poghosyan, Lucero, Rauch, & Berkowitz, 2012). Also, it limits the public's right to understand who delivered the care and it makes harder to develop continuous patient-provider relationships (Poghosyan et al., 2012). This billing mechanism must …show more content…
Foundation, the Pew Health Professions Commission, RAND Health, and The Medicare Payment Advisory Commission (MedPAC). These organizations believe payment for health care should be based on services provided rather than policies that suggest a particular provider type is more valuable over another (Poghosyan, 2012). Also, APRNs should have a fully extended scope of practice for the ideal health care delivery
APRNs have been dealing with the different scope of practice in state and federal policies, old insurance reimbursement models, and institutional practices. The laws, policies and regulation around billing is especially concerning as they directly affect an APRN’s independence and finances. Unfortunately, the current billing system is complicated and scattered throughout federal and state law, plus vary from payer to payer (Journal of Wound, 2012). As a result, it is necessary to understand billing regulations and …show more content…
This system allows physicians to bill for services performed by other members of the care team, including NPs. This practice allows the billing party to receive 100% of the physician fee schedule for the services rendered vs. if it was billed by and NP using their Medicare Provider ID which would only receive 85% of the physician fee. It's an irrational payment mechanism, but beneficial financially, for this reason, APRNs have accepted this billing practice. With this system, NP services are invisible as an independent care provider. In other words, APRNs are not given credit for being the PCPs of the record thus it's difficult to collect data and evaluate their services (Poghosyan, Lucero, Rauch, & Berkowitz, 2012). Also, it limits the public's right to understand who delivered the care and it makes harder to develop continuous patient-provider relationships (Poghosyan et al., 2012). This billing mechanism must …show more content…
Foundation, the Pew Health Professions Commission, RAND Health, and The Medicare Payment Advisory Commission (MedPAC). These organizations believe payment for health care should be based on services provided rather than policies that suggest a particular provider type is more valuable over another (Poghosyan, 2012). Also, APRNs should have a fully extended scope of practice for the ideal health care delivery