Business And Legal Considerations For The Agacnp. Reimbursement

been restricted on what they can and can’t do including signing certain documents and orders they can prescribe. With the Affordable Care Act the demand for primary care providers is growing (Gadbois, Miller, Tyler, & Intrator, 2015). This means that the need for APRNs is rising and the need change is approaching. In the primary care setting, there is a variety of medical staff working including medical assistance, LPNs, and RNs. This can become more for the APRN when delegating medication administration. When the APRN cannot delegate medication administration the quality of patient care is sacrificed and is not productive in providing care to the patients.

While uncertainty about the role of an Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) persists, what research has found about the role is that AG-ACNP’s provide advanced nursing care to those who are acutely, critically or chronically ill in both traditional and nontraditional healthcare settings (Kleinpell et al., 2012). Standard of scope differs between all types of scopes and nurse practitioners alike. The scope of practice (SOP) for an Acute Care Nurse Practitioner (ACNP) is not based on practice setting, but rather what type of care the patient will need, for example, someone who needs ventilator management in either the home or hospital environment (Kleinpell et al., 2012).

The patient is informed about their coverage and the amount of copayment they would have to pay.

Insurers are less likely to reimburse APRN’s in states that mandate physician supervision. Nurses need to push for reform of the regulations governing APRN;s.

Indemnity insurance system is on a retrospective payment system. This is where you are automatically responsible to pay the fees for seeing the provider. Then you will be reimbursed for the cost a latter date. You are responsible to take care of any charges that you make incur.

Currently, the Affordable Care Act establishes nurse practitioners as providers whom are eligible providers in ACOs; however, the current Medicare Shared Savings program statute prevents beneficiaries of Medicare, who are receiving primary care service from a nurse practitioner, from being assigned to Accountable Care Organizations inside the program (AANP, 2015). The American Association of Nurse Practitioners (2015) also claim the exclusion of nurse practitioners must be repealed if ACOs want to develop further as models of practice, which improve cost effectiveness, patient access and quality.

by a nurse equivalent is equivalent to care provided by a physician.. In addition, the

With the passing of the Affordable Care Act in 2010 approximately 32 million more people will be insured throughout the United States. The need for healthcare workers and providers will be in drastic demand to provide care to these insured Americans. The 2010 IOM report details out how the advanced practice nurse can be a valuable asset in primary, chronic and transitional care and their skill set should be used to promote better healthcare across the nation (IOM, 2010). This impact of this report should help progress advanced practice nurse’s ability to practice without individual state regulation and be governed under one body to server in and outside of the hospital setting

Reimbursement for the advanced practice nurse (APN) is improving but how they fit into reimbursement systems is vey important. One question that arises is if the APN should be paid the same fee for service as a physician or should only a percentage of the payment be received. Most third-party reimburses, which include a few large insurance companies are now reimbursing APNs and more states are getting on board with reimbursements by developing reimbursement models for APNs (Hamric, 2009). For example, Aetna US Healthcare, Anthem Blue Cross and Blue Shield of Kentucky, Medicare and Medicate all credential NPs as primary care providers and pay at 85% of the physician rate. Tricare of Kentucky credentials NPs and pays 100%.

The Gerontology Primary Care Nurse Practitioner competencies entail a combination of acute gerontology and primary care. In order to gain entry into this field, there is need to meet the requirements for an adult-gerontology care nurse practitioner. The competencies of this field are based on the APRN along with NP core competencies. Their scope of practice is based on patient healthcare needs. Their healthcare obligations tend to reflect the work of a national Expert Panel that entails a host of adults related to gerontology and acute care (Geetter, et al., 2013).

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

Many people do not ponder on the possibility of some form of malpractice or misdiagnosis occurring during their time as patient. They put their trust solely in the healthcare provider. More importantly nurses hardly ever consider being the one that causes harm or the one whom neglects a patient, let alone misdiagnose a patient. When entering the nursing field one needs to look at all options that will help protect them from sustaining any loss. Many nurses in today’s time are purchasing profession liability insurance or more commonly known as professional indemnity. Professional indemnity helps pay for expenses that occur during malpractice, negligence, and misdiagnosis lawsuits.

of the physicians can be defined. MGOA can then start to assign cost requirements to each physician

APCs or "Ambulatory Payment Classifications" are the government's method of paying facilities for outpatient services for the Medicare program. A part of the Federal Balanced Budget Act of 1997 required HCFA (now CMS) to create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services -analogous to the Medicare prospective payment system for hospital inpatients known as "Diagnosis Related Groups" or DRGs. This OPPS was implemented on August 1, 2000. APCs are an outpatient prospective payment system applicable only to hospitals, and have no impact on physician payments under the Medicare Physician Fee Schedule.

This rewards quantity over quality. Fee for service does nothing to promote low cost, high value services, such as preventive care or patient education even if they could considerably enhance patients’ physical condition and reduce health care costs through the system. 78% of employer sponsored health insurance is was fee for service. Reimbursement is the form of payment for services provided. The most common practice is the insurance company pays to the provider directly. Under the MCO when receiving care the patient is usually required to pay a small amount out of pocket such as 15 or 20 dollars and the rest is picked up by the managed care plan.