Centers for Medicare and Medicaid Services and Reimbursement Essay

1307 Words Feb 8th, 2013 6 Pages
Is national certification important with respect to billing and reimbursement? When? Discuss reimbursement barriers and issues that hinder or prevent APNs from receiving reimbursement for services rendered. What are steps APNs must take to increase the likelihood for reimbursement?

Qiuyue Li
Asuza Pacific University
Karen D French

1. The Question
I believe national certification is important with respect to billing and reimbursement. National certification is often required in order to acquire proper credentials. For example, certification is now required to acquire a credential from Medicare, Medicaid, and the Department of Veteran Affairs. Health insurance companies also require certification for credentialing. APNs
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On another note, nurse practitioners familiar with various requirements when it comes to documentation to sustain appropriate CPT coding should refer themselves to the HCFA rules and the Federal register for guidelines. The nurse practitioner should actively participate on internal audit of documentations that support the CPT code billed.
3.Medicare Reimbursement Process Issue
Many APNs inaccurately presuppose that receiving an APN license eliminates all obstructions to getting reimbursements for all their services by the insurance companies. The primary goal obviously is to achieve “direct reimbursement,” which basically means being able to bill in the APN’s exact name and not that of or under the physician. This is because being billed under a doctor’s name austerely propagates the invisibility of the nurse practitioners. The frequent misconception of many APNs about Medicare is that if a contributor gets a Medicare number, he or she will be reimbursed mechanically by every other

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