Reimbursement In Nursing

Decent Essays
Dillon and Hoyston discuss critical steps in establishing reimbursement for a new NP, whether this is part of an existing practice or a new practice. Initially, each NP needs to apply for a National Provider Identification Number (NPI). “The Health Insurance Portability and Accountability Act (HIPPA) of 1996 mandated a standard of unique identifiers for health care providers and health plans” (Dillon & Hoyston, 2014, p.57). While the Centers for Medicare and Medicaid Services established the National Plan and Provider Enumerator System to provide practitioners with unique identification. This NP currently has a NPI number that would require updating for additional practice sites. Additionally, to ensure reimbursement NPs would want to…show more content…
The Oregon Health Authority lists OHP 3114; OHA 3972; OHA, 3974; OHA 3975 as the forms required for behavior health PMHNPs to file. At the practice expands to include additional providers, OHA lists the same required forms for family nurse or other nursing practitioners. There are provisions for naturopaths and chiropractors to register for provider numbers to request reimbursement for services provided, should the practice expand and include other professionals in addition to advanced practice nurses. Rural Health Clinic Status is listed as a #14 provider type should the additional providers choose to form a Rural Health Clinic focused on wellness, with the joint value of an integrative health philosophy of practice, as a group rather than co-located individual providers. Dillon and Hoyston (2014) recommend using the to credential for most managed care programs, in one place, especially if you don’t have a practice manager to assist with competing applications and filing. Consequently, understanding how to use coding for practice is crucial. Dillon and Hoyston (2014) note that the “current Procedural Terminology codes
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