Acute Care Nurse Practitioner

Paper Summary:

In this article the writer explains that the legal definition of a nurse practitioner differs between states and that the scope of practice of a nurse practitioner also varies considerably from one state to another. The writer also points out that as all nurse practitioners in every state perform physician services in critical care, they must conform to their particular state's requirements. The writer then points out that while Medicare requires that a nurse practitioner be authorized, under state law, to perform any service that is billed, state laws governing nurse practitioners' scope of practice differ to a significant degree. The writer maintains that numerous hospitals and other facilities are uninformed about the rules and procedures related to billing for nurse practitioners' services. The writer concludes that while research has indicated that nurse practitioners provide the same quality of care in acute care settings as do physicians, the same demands are made on them with the potential for legal problems.

From the Paper:

"The nurse practitioner's services are reimbursed through the facility fee or Diagnostic Related Group payment to the hospital. The main opportunities for billing nurse practitioner services are located in evaluation and management procedure codes. While the patient pays 20 percent of the physician fee schedule rate, Medicare pays 85 percent of 80 percent of the Physician Fee Schedule rate for physician services billed under a nurse practitioner's provider number. The American College of Nurse Practitioners maintains that this problem is the result of a problematic annual update formula so that Medicare payments to all providers of services are threatened with reductions each year. Since nurse practitioners receive just 85 percent of the reimbursement that physicians obtain, the reductions are substantial. Within the current system, payment updates for providers are linked with the U.S. Gross Domestic Product (GDP) growth."

Sample of Sources Used:

• American Academy of Nurse Practitioners (2005). Medicare update. Office of Health Policy. Accessed January 20, 2007. http://www.aanp.org
• American College of Nurse Practioners (2007). Medicare provider payment cuts. Accessed January 20, 2007. http://www.acnpweb.org
• Bruce, K. & Steinke, E. (2006). The acute care nurse practitiioner in hospital-based practice. The Kansas Nurse, 81 (5), 3-5.
• Buppert, C. (2005). Third-party reimbursement for nurse practitioners' services on trauma teams: Working through a maze of issues. The Journal of Trauma, Injury, Infection, and Critical Care, 58 (1), 206-212.
• Clinton, P. & Sperhac, A. (2005). The acute care pediatric nurse practitioner. Journal of Pediatric Health Care, 19 (2), 117-120.

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