Financing and Health Care Policy and the role of the NP

Financing and Health Care Policy and the role of the NP

SECTION A (1.5pages minimum)
Reimbursement for NP Services
Reimbursement processes and rates for services provided by NPs vary between funding sources.
Differentiate between public, private and managed health care plans. Research the application
process for NPs to join the panels for reimbursement and the rates of reimbursement for services
provided by NPs. Share with your colleagues which panel(s) you researched and what you
learned.
Include a reference list at the end of this section 4 minimum.
SECTION B (1.5 pages minimum)
Healthcare Reform and the NP
Health care reform has prompted numerous debates in regard to reimbursements for providers,
such as NPs, Physician Assistants (PAs) and MDs. What are the arguments, data, and rationale
used by proponents and opponents of healthcare reform? What is your perspective on the
implications of healthcare reform in regard to the role of the NP?
Also, in less than 300 words assess how regulatory, legal, and legislative issues impact advanced
practice nurses and discuss how this plays into healthcare reform.

SECTION A: Reimbursement for NP Services

Reimbursements for the services provided by nurse practitioners (NP) constitute a significant
part of the health care programs offered in the United States of America and there are
considerable variations in the extent of reimbursement rates according to the processes adopted
as well as between funding sources (Safriet, 1992). For example, there a various public, private
and managed health care plans in the US and there are relative variations between them on basis

FINANCING AND HEALTH CARE POLICY 2
of the reimbursement rates as well as adopted reimbursement process. In particular, the major
health care plans include Medicare, Medicaid as well as commercial indemnity insurers, health
maintenance organizations and/or commercial managed care organizations (MCOs) and finally
schools or businesses that want provision of health services for their student or employees
respectively. Each of the above mentioned health care plans have varied rules and regulations on
reimbursement process and rates for the services provided by NPs (Safriet, 1992).
The particular differences that exist between the above mentioned health care programs are in
form of management, ownership as well as reimbursement rates as well as reimbursement
process. For example, both Medicare and Medicaid health care programs are managed by the
government to provide health insurance services to its citizens who meet threshold requirements
for inclusion (Stanley, 2010). All the latter health care programs are privately managed or
managed by non profit making organizations. Moreover, these health care programs are
differently owned where both Medicare and Medicaid are owned by the government while the
rest health care programs are either privately managed or managed by non profit making
organizations.
Furthermore, in order for the NPs to join the panels for reimbursement the application process
also vary considerably as well as the reimbursement rates for the health care services that the
NPs provide (Stanley, 2010). In particular, the for an NP to join the Medicare reimbursement
panel, the must be holders of state licenses as an NP while at the same time an holder of a
certification as an NP by a nationally recognized certifying professional body. Some of the
nationally recognized professional bodies for certifying NPs include National Certification
Corporation, Americans Nurses Crediting Center, Critical Care Certification Corporation, as well

FINANCING AND HEALTH CARE POLICY 3
as American Academy of Nurse Practitioners (Stanley, 2010). Moreover, since January 1, 2003
individuals who intend to apply for Medicare reimbursement panel must also be in possession of
a master’s degree from a recognized institution of higher learning. Upon meeting the above
mentioned requirements an individual NP can apply to join Medicare reimbursement panel
(HealthCare.gov).
According to Medicare the reimbursement rates to the services provided by NPs, the NPs are
paid 80 per cent of the 85 per cent of the rate of physicians Fee Schedule for any medical
procedure where an NP participates since in Medicare an NP must always offer his/her services
in conjunction with a physician to qualify for reimbursement (Medicare & Medicaid Services).

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