Third-party reimbursement for nurse practitioners' services on trauma teams: Working through a maze of issues

Journal of Trauma - Injury, Infection and Critical Care

Volumn 58, Issue 1, 2005, Pages 206-212

  Buppert, Carolyn ^a  

^a Law Office of Carolyn Buppert   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CERTIFICATION; CONSULTATION; HEALTH CARE QUALITY; HOSPITAL BILLING; HUMAN; LEGAL ASPECT; MEDICAID; MEDICAL FEE; MEDICARE; NURSE PRACTITIONER; NURSING EDUCATION; PHYSICIAN; PRIORITY JOURNAL; REIMBURSEMENT; REVIEW; TRAUMATOLOGY;

FORMS AND RECORDS CONTROL; HUMANS; INSURANCE, NURSING SERVICES; NURSE PRACTITIONERS; PATIENT CARE TEAM; REIMBURSEMENT MECHANISMS; TRAUMA CENTERS; UNITED STATES; UNITED STATES CENTERS FOR MEDICARE AND MEDICAID SERVICES;

EID: 13544263444     PISSN: 00225282     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.TA.0000152685.81057.28     Document Type: Review

References (31)

1. http://www.medicare.gov/Glossary/. Accessed December 29, 2004. [Go to www.medicare.gov and search for "glossary."]
2. Consult state law, a state Board of Nursing Website, the National Council of State Boards of Nursing Website (www.ncsbn.org), or Buppert, C. The Nurse Practitioner's Business Practice and Legal Guide, 2nd edition. Sudbury, MA: Jones & Bartlett Publishers; 2004.
3. Code Me. R. §02 380 008.
4. MD. Regs. Code tit. 10 §27.07.02.A.
5. Cal. Code Reg. tit. 16 §1485.
6. Buppert, C. Billing Nurse Practitioner Services in Specialists' Offices, Hospitals, Nursing Homes, Homes and Hospice. Annapolis, MD: Law office of Carolyn Buppert; 2004.
7. Aston G., Foubister V. Drawing the line on scope of practice: delegates oppose independent reimbursement for advanced-practice nurses and other scope-of-practice expansions. Am Med News. July 20, 1998; http://www.ama-assn. org/amednews/1998/pick_98/anna0720.htm.
8. See each of the state's laws, available from the Board of Nursing, or see Buppert, C. The Nurse Practitioner's Business Practice and Legal Guide, 2nd edition. Sudbury, MA: Jones & Bartlett Publishers; 2004.
9. http://www.rushu.rush.edu/nursing/pos/masters_acute_care_acnp.html. Accessed December 29, 2004.
10. http://www.nonpf.com/evalcriteria2002.pdfand http://www.nonpf.com/ ACNPCompsfinal20041.pdf. Accessed December 29, 2004.
11. The content outline for the certification examination for acute care nurse practitioners is online at http://www.nursingworld.org/ancc/certification/ cert/exams/TCOs/ACNPTCO.html. Accessed December 29, 2004.
12. See each of the state's laws, available from the Board of Nursing, or see Buppert, C. The Nurse Practitioner's Business Practice and Legal Guide, 2nd edition. Sudbury, MA: Jones & Bartlett Publishers; 2004.
13. Based in part on personal communications from nurse practitioners working in trauma centers and in part on survey data reported In: Kleinpell R. The acute care nurse practitioner: a new career opportunity for critical care nurses. Crit Care Nurs. 1997;17:66-69.
14. Social Security Act §1861(s)(K)(i). (Balanced Budget Act of 1997).
15. Social Security Act §1861(s)(K)(i). (Balanced Budget Act of 1997).
16. Social Security Act §1861(s)(K)(i). (Balanced Budget Act of 1997).
17. Required by Medicare's rules on reassignment, Medicare Carriers Manual, Part 3, §3060. Until December 2003, Medicare had strict requirements about the conditions under which other entities may receive payments for physicians' and nurse practitioners' services. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 broadened the circumstances under which a nurse practitioner or physician can reassign his or her Medicare reimbursements to another party. In the past, a nurse practitioner could receive Medicare payments directly or could reassign his or her right to receive Medicare payments to his or her employer, or, if the nurse practitioner was performing services in a facility, under contract with the facility, the nurse practitioner could reassign his or her right to receive payments to the facility. Under the new law, as of December 8, 2003, a nurse practitioner can reassign contractually his or her right to receive Medicare payments to an entity if the entity doing the billing meets certain requirements determined by the Secretary of Health and Human Services. The nurse practitioner and the entity billing the nurse practitioner's services need not have an employer-employee relationship and the services need not be performed in a facility. The nurse practitioner and entity doing the billing must have a contract that reassigns the right to be paid from the nurse practitioner to the entity doing the billing.
18. 42 CFR §410.75.
19. Required by Social Security Act §1861(s)(K)(i) and the laws of most states.
20. Medicare Carriers Manual, Part 3, §15501.
21. Medicare Carriers Manual, Part 3, §15506.
22. 42 USCS §1396d(a)(xi)(21).
23. Revision 2003, page 32.
24. "Attention: Physicians, Optometrists, Chiropractors, Podiatrists, CRNAs, Independent Nurse Practitioners, Independent Nurse Midwives: Assistant at Surgery Policy and Codes," April 1999; http://www.dhhs.state.nc.us/dma/ bulletin/pdfbulletin/0499bulletin.pdf.
25. Wellmark Practitioner Guide, April 2003:3.
26. Tye CC, Ross F, Kerry SM. Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey. J Accident Emer Med. 1998;15:31.
27. Rudy EB, Davidson LJ, Daly B, et al. Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison. Am J Crit Care. 1998;7:267-281.
28. Rhee K, Dermyer A. Patient satisfaction with a nurse practitioner in a university emergency service. Ann Emer Med. 1995;26:130-132.
29. Spisso J, O'Callaghan C, McKennan M, Holcroft JW. Improved quality of care and reduction of housestaff workload using trauma nurse practitioners. J Trauma. 1990;30:660-665.
30. Hooker RS, McCaig L. Emergency department uses of physician assistants and nurse practitioners: a national survey. Am J Emer Med. 1996;14:245-249.
31. Stetler C, Effken J, Frigon L, Tiernan C, Zwingman-Bagley C. Utilization-focused evaluation of acute care nurse practitioner role. Outcomes Manag Nursing Pract. 1998;2:152-160.