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 http://www.oagh.org/site 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
The hospital that the clinic is attached to is opening a brand new facility and has decided to expand their community support by opening a family medicine clinic that will utilize the hospital resources. The community is a wide range of working classes, low income, poor, and rural families that must travel some distance to reach health care providers. Attracting patients that need primary care and continued health care will drive referrals to the ancillary departments in the hospital. This increases revenue for the hospital.
the population that the health center caters to must be identified as an unserved or underserved one
Traditionally, it is custom that patients to travel to the provider. Although it is possible to create an establishment for patients to visit providers, Mullin & Stenger (2013), advise patients choose home care in which the provider travels to them. According to Buchan, Couper, Tangcharoensathien, Thepannya, Jaskiewicz, Perfilieva, & Dolea (2013), the World Health Organization provides favorable recommendations to procure health care professionals into the rural environment. These recommendations include providing further education opportunities, improved living conditions, career development programs, incentives such as public recognition, and a safe and supportive work environment. Another essential recommendation is to implement jobs for multiple scopes of practices and varieties of health care workers. It is important that health care providers have the support of a multidisciplinary work staff to implement safe and efficient
Given our rural veterans' and other non-veterans need for access to high quality healthcare, allowing nurse practitioners to practice with full authority in the rural and underserved areas will increase access to care, decrease lengthening delays in healthcare delivery, decrease healthcare costs, and promote patient safety. This is why I urge you to move forward with the proposal to recognize nurse practitioners to practice within their full scope in the rural and underserved urban
“The Tax Equity and Fiscal Responsibility Act (TEFRA), signed into law September 3, 1982, mandated the development of a prospective payment methodology for Medicare reimbursement to hospitals.” http://sunlightfoundation.com/blog/2009/09/08/slug/. It changed Medicare reimbursement from a fee for service to prospective payment system. Which is where there`s a reimbursement method where`s there an amount of payment determined in advance of services being performed. The rates are done annually. Reimbursements for inpatient care by a classification scheme called diagnosis-related groups. If the patient might have to stay longer in inpatient care more than average days, the hospital may lose money on that patient.
To respond to these legislative changes, there must be an increase in the professional workforce of rural health. The existing workforce will need extensive training to deal with the new aspects of the Affordable Care Act, and new professionals need to be encouraged to practice in rural areas. The following are potential methods for increasing the health care workforce of rural and frontier America:
Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the
The Patient Protection and Affordable Care Act (Obamacare) had mame dramatic changes in the field of the health care system, especially in Medicare, that will seriously take effect in American seniors. Indeed, much of the health law’s new spending is financed by spending reductions in the Medicare program. In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.( Elmendorf, letter to Speaker Boehner). About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage to a rasonable
The Commonwealth Fund, New York. (2006). US Medicare Prescription Drug Coverage. Retrieved from US Me
Significant health disparities between rural and urban populations have been a major concern in the United States. One prominent factor contributing to the disparities is lack of access to quality care in rural areas which is closely associated with challenges faced by rural health care providers (National Rural Health Association, 2007). Rural hospitals are the key health care provider in rural areas, offering essential health care services to nearly 54 million people (American Hospital Association, 2006). They face a series of challenges such as workforce shortages, rise in health care costs, difficulty in finding access to capital, difficulty in
RECOMMENDATIONS: Establish healthcare incentive programs to draw providers to rural areas. Increase funding to upgrade existing providers and facilities. Change state licensing policies to allow Nurse Practitioners to practice as Primary Care Providers.
Rural Americans face an exclusive combination of issues that create disparities in health care that are not found in urban areas. Many complications met by healthcare providers and patients in rural arears are massively different than those located in urban areas. Financial factors, cultural and social variances, educational deficiencies, lack of acknowledgement by delegates and the absolute isolation of living in remote rural areas all combined to hinder rural Americans in their struggle to lead a normal, healthy life. Rural hospitals located in rural areas faces many disadvantages, such as; minimum resources, shortcoming or unprepared professionals, and financial disparities. Although many of these challenges could be solved
Hello Dr. Sanner and class. There are millions of people in the United States that live in rural areas. Some work on farms, ranches, and some are agricultural suppliers. These rural populations are more likely to be poorer, sicker, older, uninsured, and medically underserved than urban populations. With a population that is older, poorer, and with less employer-based health insurance coverage, a larger segment of the rural population is dependent upon public health care programs such as State Children’s Health Insurance Programs (SCHIP), Medicare and Medicaid. The health care infrastructure in much of these rural areas consist of a lot of small hospitals, clinics, and nursing homes, and often experience significant financial stress. Many rural
This paper discusses three major factors when considering health care in a rural community with
Assessing Healthcare services is an important factor for individuals in rural areas in order to decrease physical and emotional stress. In many rural areas, there are barriers that one may face such as, lack of transportation, shortage of physicians in the area and lack of health care services. With these barriers, rural communities face more sickness and deaths. In this paper, the author will discuss factors that sustain health care services in rural communities and how to make it better with a proposed solution that may assist with this issue.