What is required to get reimbursed by Medicare, Medicaid and private Insurances.


Page 4
Reimbursement Issues and Realities
Because much of the funding for hospitals and much of the reimbursement for office practice comes from Medicare, federal statutes and regulations and policies from the Center for Medicare and Medicaid Services (CMS) have great impact on the interest of hospitals and medical practices in having NP providers. For example, the Social Security Act, which governs Medicare and Medicaid, was written in 1965, before there were NPs. The Act frequently uses the word “physician” as if there were no other healthcare provider. Other healthcare providers have had to get acts of Congress to be included in the laws governing Medicare. The Act has been amended many times since the 1960s, but some relevant portions of the Act remain that give permission to physicians and only physicians to provide care. NPs made progress in 1997 when an act of Congress authorized NPs to be reimbursed directly for the care of Medicare patients (Buppert).

1. Research the reimbursement realities in your state.
2. What is required to get reimbursed by Medicare, Medicaid and private Insurances.
3. How do you apply for provider status?

Page 5
Marketing, Negotiating and Developing APN roles
1. Research the requirements for an independent APN practice in your state
2. Discuss what should be included in a contract that you negotiate for a APN position.
3. Note if your state requires a collaborative or supervisory physician and what type of agreement would be required in these cases.
4. Review the circumstances when a collaborative agreement would be required.
5. Discuss what should be included in a collaborative agreement in your state (many times defined by your state statutes).

Page 6
Lifelong learning and the APN
1. Discuss the importance of lifelong learning for the APN. (This may be required for negotiations for continue education monies and time).
2. Discuss important ethical issues that you anticipate to be a part of your APN practice.
3. Reflect on how you will apply Research to the health delivery system you will be working within and your APN practice.




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