What are the major barriers for optimal reimbursement?
Most practitioners are educated in the clinical aspects of becoming an APRN, however, little time is devoted to the business aspects. In this time where APRNs can transform health care, we need to understand how we are paid to sustain a practice whether employed by or owner of a practice.
Lack of understanding in the reimbursement process can result in missed opportunities to capture revenue or perhaps trigger an audit.
What facilitates reimbursement?
One needs to understand the mechanism of how revenue in a practice is generated. Using E&M coding is important but even moreover with the shift from procedure to value based payment, education is critical so as not to leave money on the table. APRNs cannot ignore this responsibility.
What steps will need to occur to optimize reimbursement?
There are provider issues, practice issues, patient issues and payer issues which have a bearing on the reimbursement process.
How do states with full practice authority fare in the area of reimbursement versus states with restricted practice?
Reimbursement issues are similar across the country regardless of the state practice authority. Those in more restricted states need to be aware of how billing is occurring to make sure there are no barriers to payment.
What recourse does a NP have if they feel they were not fairly reimbursed?
Advocacy, involvement at the state level and national intervention.
