Debra, I agree that advanced practice nurses need to understand billing requirements and how to work to the highest level of their license. Innovative nurse-led clinics can provide quality care for patients, understanding billing practices, how they apply to payment from insurance companies and current state and federal laws for practice are imperative. Currently the Centers for Medicare and Medicaid (CMS) have stringent laws about how nurse practitioners can be paid. There are three avenues for billing and each works differently depending on whether you are billing for an inpatient or an outpatient service. The three methods of billing include independent billing, shared billing with a physician, and “incident to” billing (Hull-Grommexh,
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NP’s can bill independently of the physician, but their reimbursement rate is only 85% of what a physician would be paid. Currently in Pennsylvania, advance practice nurses (APNS) need to have an overseeing physician to practice. They do no need to have direct supervision, but they need to sign a contract stating they will oversee the care provided by the APNs (PSNA, 2013). This will hopefully soon change, as according to the PA State Nurses Association PSNA) website twitter feed (https://twitter.com/panurses?ref_src=twsrc%5Etfw), the PA Senate voted in favor of Senate Bill 717 on July 12, 2016, which would allow NPs to practice independently without an overseeing physician. NPs can also bill as a shared appointment and receive 100% reimbursement, but both the NP and the physician need to have a face-to-face encounter documented. The final way that a NP can bill is call “incident to” billing. In this scenario the physician must have at least one visit with the patient and must physically work in the same building as the NP, but future visits can be completed independently by the NP with the physician documenting involvement in the patients care with the initial assessment (Hull-Grommexh, Ellis and Mackey,
NP’s can bill independently of the physician, but their reimbursement rate is only 85% of what a physician would be paid. Currently in Pennsylvania, advance practice nurses (APNS) need to have an overseeing physician to practice. They do no need to have direct supervision, but they need to sign a contract stating they will oversee the care provided by the APNs (PSNA, 2013). This will hopefully soon change, as according to the PA State Nurses Association PSNA) website twitter feed (https://twitter.com/panurses?ref_src=twsrc%5Etfw), the PA Senate voted in favor of Senate Bill 717 on July 12, 2016, which would allow NPs to practice independently without an overseeing physician. NPs can also bill as a shared appointment and receive 100% reimbursement, but both the NP and the physician need to have a face-to-face encounter documented. The final way that a NP can bill is call “incident to” billing. In this scenario the physician must have at least one visit with the patient and must physically work in the same building as the NP, but future visits can be completed independently by the NP with the physician documenting involvement in the patients care with the initial assessment (Hull-Grommexh, Ellis and Mackey,