Reimbursement In Nursing Care

There is a growing trend where physicians are choosing different specialties instead of choosing primary care, primarily due to the low reimbursement rate in primary care. According to Iglehart (2014),” the Association of American Medical Colleges (AAMC) still projects a shortage of 130,000 physicians by 2025, split almost equally between primary and specialty care” (para. 1). With this decline comes an answer, an increase in the number of nurse practitioners providing patient care, reported 154,00 in 2012 and growing every year (Iglehart, 2014). This increase in nurse practitioners’ helps fill that gap, allow greater health care access to the community, especially special populations. By gaining access to healthcare were a nurse practitioner is the provider not only with the special population have high quality affordable health care, a trusting long lasting relationship will develop. This relationship will break the barriers of; lack of trust, lack of health care education and discrimination. Nursing is a trusted profession that provides education and care that no other health care professional

While the demand of healthcare need increasers the United States facing a physician shortage. In recent years the number of nurse practitioners (NPs) and physician assistants (PAs) has significantly increased and they are taking the part in providing healthcare cervices to the majority of patients. I believe nurse practitioners and physician assistants can practice independently from doctors and be free of oversight. Expanding the scope of NPs and PAs is essential to overcome the healthcare crisis we are facing; it will increase patient satisfaction and stabilizing the healthcare economy.

by a nurse equivalent is equivalent to care provided by a physician.. In addition, the

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the

Retrospectively reviewing this legislation, it is unknown as to why nurse practitioners were not granted 100% reimbursement or why the nursing profession accepted this payment scale. Every government policy is implemented within a historical perspective. Fluctuations in the environment and economic constraints have an immense effect on the ability of legislation to pass the many obstacles of government (3). In 1997 the government was undergoing vast budget cuts due to a declining economy. Although the American Nurses Association, state nurse practice organizations and nurse lobbyists originally argued for 97% of the physician reimbursement, however due to the current budget cuts the assumption that a lesser percentage would be more successful

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

The adult-gerontology acute care nurse practitioner (AGACNP) has many responsibilities. In addition to providing excellent patient care, the AGACNP must also know how to code for patient services, bill appropriately and know how much they should expect in reimbursement for specific treatments. Many legal issues arise for the AGACNP, including several forms of negligence; the AGACNP should be educated on the essential elements. Finally, the AGACNP must educate themselves and be prudent to avoid legal issues related to malpractice. In the following paragraphs, each of these issues will be discussed.

Without full practice authority for nurse practitioners, there are a number of disadvantages that will be experienced by both NPs as providers and their patients. The Affordable Care Act and Medicaid expansion has made healthcare more affordable and accessible. While this is a great step to improving the overall health of America, a shortage of provider continues to be a problem. With more people utilizing healthcare services, it is important for NPs to be given full practice authority. The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorizations Act is one legislations that has partially addressed this issue.

Effective payment program strategies are a major part of administering health care. Reimbursement programs are a part of the United States (U.S) health care system. They represent a financial tool for providing cash flow to service physicians and hospitals. Most often, the ability to provide quality health care depends on the payment for the services given by physicians and hospitals. This paper presents a view of payment reimbursement systems within the health care industry. A comparative overview and description of payment reimbursement will be given in order to understand the flow of finances in the health care industry. The focus will be on the levy and fee-for-service reimbursement systems. Readers will then be able to conclude that

Nurse Practitioners (NP) are known to generate a large portion of revenue into their practice, but their worth is more than just financial. NPs are valuable contributors to their workforce and bring with them expertise, knowledge, skills, compassionate care, high quality care, and holistic treatment plan to achieve their patient well-being. NPs contribute to the productivity in their practice, which can be measured in their clinical services and an increase in revenue. As stated by Packard (2014), NP’s contributions are at times hidden by coding and billing because of many reimbursement policies, which may bill physicians for services NPs provide.

Recently, I have been reading publications regarding the “debate” over what type of patients should be seen by which licensed professional. Frequently this discussion revolves around the use of Nurse Practitioners, or Physician Assistants versus Physicians. Well-discussed arguments for both are abundant.

In spite of such challenges nurse practitioners not only made a name for themselves, they began to legitimize the profession. In the 1970’s, they showed that they increased the availability of primary care services and that both the patients and the physicians were satisfied with their care. In the 1980’s the number of physicians skyrocketed and became surplus, thus employers focused in controlling the ever growing cost of care. As a counter, nurse practitioners conducted studies on increasing scientific rigor.

Bringing more APRN in the medical field, helps with focus being on lifting the legal barriers in different states that do not allow advance practice nurses to practice to carry out to the highest of their capabilities (IOM, 2010). When there are more APRN in practice, this will help address the increase in the lifespan of patients, the need for affordable health care and not enough primary care physicians to cover the load of patients in need of care. Nurses will be the first line for disease prevention and health promotion for many patients. Statewide standardization of legal problems affecting the scope of practice to permit nurse practitioners and APRNs to evaluate patients and prescribe medications without being under a medical doctor should not be a problem (IOM, 2010).

These impose severe constrictions on the ability of the nurse to move forward or advance into the areas of practice where traditional nursing practices were not allowed {Institute of Medicine, 2010}. However with the increase in the number of nurses graduating with advance degrees in nursing; the situation is changing. These well educated nurses are leading the charge to confront the complex issues that the rapidly changing health care situation presents. Regulatory barriers must be lifted so that nurses can practice within their scope in order to be reimbursed by private insurance for the services they provide. These changes can be done through the federal and state legislators as well as supervisory agencies and bodies such as congress and licensing regulatory boards. The IOM also recommends that nurses will expand their scope of practice and increase their responsibility through teaching and counseling of patients. {Institute of Medicine,2010}. The use of Advance Practice Registered Nurses and Physician Assistant in providing primary care services will decrease wait time and increase patient satisfaction. The high turnover of nurses transitioning from school to practice also affects the quality of care. These nurses do not have enough experience to make decisions in patient care.{Institute of Medicine,2010}.The IOM and JCAHO{2012} report supports the recommendations for the introduction of nursing residency