The Reimbursement Mechanisms Essay Discussion

The Reimbursement Mechanisms Essay Discussion

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For advanced practice registered nurses (APENs) the reimbursement mechanisms vary depending on the specific policies in different states and the type of insurance (Phillips, 2022)The Reimbursement Mechanisms Essay Discussion. This discussion provides a discussion of these reimbursement mechanisms. They include Medicare, Medicaid, private insurers, and HMOs.

• Medicare- this is an insurance program for older people above the age of 65 years and disabled people. It is a federal health program that does recognize and reimburses the services that are provided by APRNs (Phillips, 2022).
• Medicaid-a joint state and federal program that provides insurance coverage to people with low-income sources. The reimbursement of Medicaid for APRNs also does vary from one state to another. In some states, APRNs are recognized as primary care providers and therefore they are given direct reimbursement for their services (Phillips, 2022). In other states, collaboration or physician supervision is required for reimbursement.
• Private Insurers-services provided by the APRNs such as CNSs, NPs, CRNAs, and CNMs are recognized and reimbursed by the private insurance companies (Phillips, 2022). The reimbursement rates vary depending on the insurers.
• Health Maintenance Organizations-these refers to a certain type of managed care organization for the fixed premium members (Phillips, 2022)The Reimbursement Mechanisms Essay Discussion. the mechanisms vary within the HMOs though most of them do recognize and reimburse the APRNs’ services.
  

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There are differences between nonphysician providers like APRNs and physicians where physicians for example can have higher rates compared to APRNs. Different factors such as payer services, scope of practice, and state regulations determine specific fee schedules.  The overall reimbursement rates can be affected by these differences

In my state Florida, there are limitations to the ownership of reimbursement practices by the APRNs. Most policies require them to be under the supervision of physicians. Even though they are authorized to diagnose, prescribe and treat, it is a must that they do it in collaboration with the physicians (Ritter et al., 2020).

References

Phillips, S. J. (2022). 34th Annual APRN Legislative Update: Trends in APRN practice authority during the COVID-19 global pandemic. The Nurse Practitioner, 47(1), 21-47.

Ritter, A. Z., Bowles, K. H., O’Sullivan, A. L., Gilman, D. J., & Fairman, J. A. (2020). Nurse practitioner state-required collaborative practice agreements: A cross-sectional case study in Florida. Nursing Economics, 38(4), 185-193. The Reimbursement Mechanisms Essay Discussion

Week 4 Discussion Forum

• Describe the reimbursement mechanisms (Medicare, Medicaid, private insurers, and HMOs) for APRNs
• Are there any differences in the fee schedules between Physicians and non-physician providers (NPP) such as APRNs? Please describe.
• Can APRNs own their own practices in your state? (My state is Florida) Why or why not?
• Support all responses using at least one scholarly source other than your textbook.
• Use national guidelines and evidence-based research when applicable.
• Students may enhance responses with an example, either from personal experience or from the media, which illustrates and supports ideas.
• All sources must be referenced and cited using the correct APA format (including a link to the source). The Reimbursement Mechanisms Essay Discussion