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Important NP Issues
Editorial
Important NP Issues
A
Marilyn W. Edmunds PhD, NP
www.npjournal.org
s state legislative sessions end their year, nurse practitioners (NPs) in a growing number of states are walking away with increased authority to practice. Some of the legislative changes provide for greater NP practice autonomy or prescriptive ability and remove restrictive ties to physicians. NPs in some states will have an increased ability to set up their own practices and work independently. This success in passing legislation may be propelled by the Affordable Care Act. Clearly, with millions of new people entering the health care system, legislators can be convinced that it is good business to allow NPs to practice to the fullest extent of their education. These legislative changes remove some irksome limitations and will facilitate NP practice. Experience has shown us that practice may precede legislative authority; legislative authority often precedes reimbursement. Thus, the next NP strategy may well be to argue to the federal government that NPs should receive equivalent reimbursement to physicians when caring for patients receiving Medicare. While practices receive 100% of the recommended Medicare reimbursement for services provided “incident to” physicians’ work, it is going to be difficult for NPs in their own offices to survive on 85% reimbursement if they begin billing under their own names. Variability in Medicaid reimbursement among the states is also an issue if more NPs are expected to care for high numbers of Medicaid patients. Insurance companies tend to follow federal policies in reimbursement, so the issue of a reduction of payment to NPs for already very low service charges is significant. Money eventually may be the next turf problem over which NPs and physicians take sides. In talking with my NP colleagues, they report that in their practices, NPs generate much more than their own salaries and overhead, which contributes to an increase in profits for a practice. One money problem they discuss is that, if more NPs practice independently, this money will go to the NP and not to the physician practice or hospital. The losers in this equation are not going to accept well this loss of control over NP reimbursement money. We are likely to see physician/hospital plans try to hold onto this money. Another more serious money issue that looms unnamed in many clinical practices is the presence of insurance and Medicare/Medicaid corruption. Until now, NPs have been mostly peripherally involved in corruption charges. Their defense is not realizing that they bear legal responsibility for the bills submitted in their names. Most NPs say they don’t know how much payers are invoiced for NP-provided services and so would not know if there is corruption or not. This is an area where NPs must become better educated. NPs must collect information about what is billed in their names. NPs will be held legally responsible for mistakes or deliberate escalation of charges. NPs must avoid getting involved in Medicare/Medicaid fraud. Temptation does exist. With the national political arena agreeing that increasing costs are a major force in growing federal deficits, all providers can expect an increased The Journal for Nurse Practitioners - JNP
A15
scrutiny of billing practices in order to detect waste and fraud that can be eliminated. As new kids on the block, NPs submitting their own reimbursement claims can expect to be closely monitored. A few reports of Medicare fraud by NPs will hurt the chance for all of us to gain greater Medicare reimbursement. Reimbursement is an issue NPs need to discuss and behavior we need to monitor.
Marilyn W. Edmunds, PhD, NP Editor in Chief
Follow Us on Twitter! JNP is working hard to keep our readers connected with the journal in as many ways as they would like. Our latest addition is Twitter, the social media tool that allows people and organizations to communicate in 140 characters or less. If you already have an account, please follow us on @JNPNow. We will keep you notified of what is in each issue of JNP and what is current and changing on our Web site. If you want to get started with Twitter and need some guidance, here are a couple of Youtube videos that will lead you through it: How to sign up: https://www.youtube.com/watch?v¼ YJSoEbNxYKE How to follow, tweet, and re-tweet: https://www.youtube. com/watch?v¼CkdXJOpqXOw
1555-4155/14/$ see front matter © 2014 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2014.09.007
A16
The Journal for Nurse Practitioners - JNP
Volume 10, Issue 9, October 2014
Important NP Issues
A
Marilyn W. Edmunds PhD, NP
www.npjournal.org
s state legislative sessions end their year, nurse practitioners (NPs) in a growing number of states are walking away with increased authority to practice. Some of the legislative changes provide for greater NP practice autonomy or prescriptive ability and remove restrictive ties to physicians. NPs in some states will have an increased ability to set up their own practices and work independently. This success in passing legislation may be propelled by the Affordable Care Act. Clearly, with millions of new people entering the health care system, legislators can be convinced that it is good business to allow NPs to practice to the fullest extent of their education. These legislative changes remove some irksome limitations and will facilitate NP practice. Experience has shown us that practice may precede legislative authority; legislative authority often precedes reimbursement. Thus, the next NP strategy may well be to argue to the federal government that NPs should receive equivalent reimbursement to physicians when caring for patients receiving Medicare. While practices receive 100% of the recommended Medicare reimbursement for services provided “incident to” physicians’ work, it is going to be difficult for NPs in their own offices to survive on 85% reimbursement if they begin billing under their own names. Variability in Medicaid reimbursement among the states is also an issue if more NPs are expected to care for high numbers of Medicaid patients. Insurance companies tend to follow federal policies in reimbursement, so the issue of a reduction of payment to NPs for already very low service charges is significant. Money eventually may be the next turf problem over which NPs and physicians take sides. In talking with my NP colleagues, they report that in their practices, NPs generate much more than their own salaries and overhead, which contributes to an increase in profits for a practice. One money problem they discuss is that, if more NPs practice independently, this money will go to the NP and not to the physician practice or hospital. The losers in this equation are not going to accept well this loss of control over NP reimbursement money. We are likely to see physician/hospital plans try to hold onto this money. Another more serious money issue that looms unnamed in many clinical practices is the presence of insurance and Medicare/Medicaid corruption. Until now, NPs have been mostly peripherally involved in corruption charges. Their defense is not realizing that they bear legal responsibility for the bills submitted in their names. Most NPs say they don’t know how much payers are invoiced for NP-provided services and so would not know if there is corruption or not. This is an area where NPs must become better educated. NPs must collect information about what is billed in their names. NPs will be held legally responsible for mistakes or deliberate escalation of charges. NPs must avoid getting involved in Medicare/Medicaid fraud. Temptation does exist. With the national political arena agreeing that increasing costs are a major force in growing federal deficits, all providers can expect an increased The Journal for Nurse Practitioners - JNP
A15
scrutiny of billing practices in order to detect waste and fraud that can be eliminated. As new kids on the block, NPs submitting their own reimbursement claims can expect to be closely monitored. A few reports of Medicare fraud by NPs will hurt the chance for all of us to gain greater Medicare reimbursement. Reimbursement is an issue NPs need to discuss and behavior we need to monitor.
Marilyn W. Edmunds, PhD, NP Editor in Chief
Follow Us on Twitter! JNP is working hard to keep our readers connected with the journal in as many ways as they would like. Our latest addition is Twitter, the social media tool that allows people and organizations to communicate in 140 characters or less. If you already have an account, please follow us on @JNPNow. We will keep you notified of what is in each issue of JNP and what is current and changing on our Web site. If you want to get started with Twitter and need some guidance, here are a couple of Youtube videos that will lead you through it: How to sign up: https://www.youtube.com/watch?v¼ YJSoEbNxYKE How to follow, tweet, and re-tweet: https://www.youtube. com/watch?v¼CkdXJOpqXOw
1555-4155/14/$ see front matter © 2014 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2014.09.007
A16
The Journal for Nurse Practitioners - JNP
Volume 10, Issue 9, October 2014