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¶ … Reimbursement barriers and issues that hinder or prevent Advanced Practice Nurses (APNs): What are steps APNs must take to increase the likelihood for reimbursement?
'An ounce of prevention is worth a pound of cure.' In addition to the stresses and the difficulties experienced by nurses in treating patients, getting reimbursed as a nurse practitioner can be an additional challenge. Taking defensive mechanisms to ensure payment is essential for APNs when navigating the thorny path of the medical insurance bureaucracy.
Government insurance programs like Medicare and Medicaid usually have fairly standardized policies for reimbursement for physician services performed by nurse practitioners. However, different private health plans often vary considerably, and it is essential that the APN understands what type of plan she is dealing with before embarking upon treatment. Even when dealing with Medicare,...
Nurses cannot merely assume that because they are ordered to perform a procedure by a physician on staff it will automatically be reimbursed, nor can they even be certain that physicians on staff are compliant with all currently-existing laws.
Nurses must take steps to be proactive regarding the process of reimbursement. Susan Cooper calls this taking responsibility and ownership of the process rather than merely being passive (Cooper 2000). Nurses must be involved reading contracts, reviewing claim submissions requirements, appeals, covered services; and understanding reimbursement terminology such as capitation vs. fee for service considerations (Cooper 2000). APNs should be…
References
Buppert, Carolyn. (2006). How to avoid reimbursement denials.
The Green Sheet, published monthly from the Law Office of Carolyn Buppert.
Retrieved June 11, 2011 http://www.buppert.com/articles/avoid-denials.php
Buppert, Carolyn. (2006). Top ten must-do. The Green Sheet, published monthly from the Law
http://www.buppert.com/articles/top-10.php
Retrieved June 11, 2011 http://www.buppert.com/articles/vague-policy-issues.php
Retrieved June 11, 2011 http://www.healthbond.com/news.php?viewStory=6835
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