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NP reimbursement

Monday February 10, 2014
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I would like to comment on the January feature ďAnswering the call: Healthcare reform will make life busier for some NPs" (www.Nurse.com/Article/Answering-the-Call). A major problem with health reform that everyone knows is the lack of primary care providers. However, what most articles donít address is how NPs have been left out of the reimbursement increases needed to increase their availability to care for the population.

I opened the first nurse practitioner primary care practice in Washington, D.C. back in 2004. As an NP we get 85% of a physician fee schedule. Medicare mandates electronic claims filing and most practices do not have onsite claims filing, meaning a billing company is paid about 7%-9% of revenue received.

Sequestration reduced all primary care payments last year another 2%, and it is foreseen that will continue this year. Medicare will begin to penalize practices that do not e-prescribe another 1% soon. After all is said and done with all of these reductions our average reimbursement has been $60-75, and that is not completely paid until it is first paid by Medicare and then the patientís secondary insurer (or the patients themselves if they have no secondary insurer), which means an average wait time to be paid of about 45-60 days.

In this area my veterinarianís visit charge is higher then what I get paid to spend 20-30 minutes with a Medicare patient to handle not only his or her chronic diseases but sometimes acute issues that require labs and conditions, meaning follow-up calls and additional unpaid time.

Itís time for a real operational management team to come in and stop paying so much for procedures and looks at the front line (primary care) and what we are expected to handle: acute, chronic, urgent care; and pay for this lifesaving care accordingly.

Erin Bagshaw, RN, MSN, C-ANP
Washington, D.C.


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