ANSWER
Mechanisms for APRN Reimbursement
Medicare, Medicaid, private insurance companies, and Health Maintenance Organisations (HMOs) are some of the ways that Advanced Practice Registered Nurses (APRNs) are compensated. According to Nursing World, APRNs who bill directly under their National Provider Identifier (NPI) are reimbursed by Medicare at 85% of the physician rate schedule. State-specific Medicaid reimbursement rates for advanced practice registered nurses (APRNs) typically range from 75% to 100% of the physician fee schedule THRIVEAP. Depending on contractual agreements and state legislation, private insurers and HMOs have varying policies; some pay APRNs at rates that are similar to those of physicians, while others give lower rates.
Disparities in Physician and APRN Fee Schedules
APRNs typically receive a smaller portion of the physician fee schedule in reimbursement. For example, APRNs receive 85% of the physician fee from Medicare for services rendered. This disparity differs between payers and states and is a reflection of policy decisions.
The Practice Ownership of APRNs in Kenya
The Nursing Council of Kenya (NCK) oversees the regulation of the nursing profession in Kenya. Although advanced practice registered nurses (APRNs), including clinical nurse specialists and nurse practitioners, are important in the delivery of healthcare, their autonomy and scope of practice—including their capacity to own and run separate practices—are governed by national healthcare policy and NCK laws. Currently, rather than operating their own independent practices, APRNs in Kenya usually operate in collaborative healthcare settings. National healthcare standards are followed and integrated care delivery is guaranteed by this framework.
QUESTION
- 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? Why or why not?