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Legislative Issues -reimbursement for Nurse Practitioners - Research Paper Example

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Reimbursements of Advanced Practice Nurses Presented in Partial Fulfillment of the Requirements for the Degree of (Insert degree) (Submitted by) (Date) The role of advanced practice nurses in the health industry has been a rising topic for debates on legislation about health care programs and policies…
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Legislative Issues Paper-reimbursement for Nurse Practitioners
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Legislative Issues -reimbursement for Nurse Practitioners

Download file to see previous pages... According to Frakes and Evans (2006), in 2003, the federal government spent 13% of its budget on Medicare services. This means that the federal government spent as much as $271 billion on providing health care services to the needy citizens (Frakes and Evans, 2006). As a result of the increasing allocation on health care programs and policies, the federal government has put significant interest in managing and controlling its costs on implementing these health care programs. In doing so, the federal government has used the legislation to control health care costs by creating a regulatory structure that will regulate resultant costs and prevent fraud within the health industry (Frakes and Evans, 2006). Because of these regulatory policies and programs, health care providers in both patient care and practice are affected (Frakes and Evans, 2006). Of the health care providers that are very much affected of the regulatory efforts set by the federal government, the advanced practice nurses (APN) are among them. Nurse practitioners (NPs) and clinical nurse specialists (CNSs) make up APNs (Frakes and Evans, 2006). According to (Hamric, Spross, and Hanson, 2009), the roles of APNs include nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs), and ), certified nurse-midwives (CNMs). ...
uently, health providers such as physicians and registered nurses are reimbursed under the Current Procedural Terminology system which is created by the American Medical Association (Frakes and Evans, 2006). In this system, which was developed in 1966, reimbursements for a service are determined through the individual provider’s relative value scale (Frakes and Evans, 2006). Subsequently, the value scale, according to Richmond, Thompson, & Sullivan-Marx (2000), is thereby established based on the professional liability insurance cost, practice expense, and work done of the provider, and then multiplied by a geographic expense adjustment modifier. Incidentally, under the reimbursement system, APNs can receive reimbursements from the government’s Medicare and Medicaid programs, commercial insurers, self-insured institutions, and managed care organizations for the services they provide (Frakes and Evans, 2006). With the Omnibus Budget Reconciliation Acts of 1989 and 1990, APNs are able to receive reimbursements; however, Richmond, Thompson, & Sullivan-Marx (2000) maintain that the limitation of this Act is that reimbursements are confined to those who practice inside skilled nursing facilities and rural areas. Another restriction to the reimbursement rights of APNs is that APNS can reimburse only for services billed as “incident to” a physician’s care but requires that the APN be employed or contracted with the physician (Frakes and Evans, 2006). Through this set-up, physicians enjoy reimbursements at 100% of their rates. Clearly, the disparity between APNs and physicians is manifested through these reimbursement policies. In a study of Ruchlin, Levey, and Muller (1975), they define the function of reimbursement programs. In their study, they utilize the ...Download file to see next pagesRead More
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