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At least 91 records · Page 5Linked to original sources
PubMed2006

Insurers' contracting policies on nurse practitioners as primary care providers: the current landscape and what needs to change.

A national survey showed that most insurance companies refuse to credential nurse practitioners as primary care providers in nurse-managed health centers. These prohibitive policies, along with weak federal and state laws, threaten the long-term sustainability of nurse-managed health centers as safety-net health care providers and limit the ability for nurse practitioners to become an accepted primary health care source in the United States. Interviews with national managed care organizations revealed that these companies' current business practice and policies are unlikely to change without regulatory change at state and/or federal levels.

Contract Services↗
PubMed2002

Forces promoting health insurance coverage of homebirth: a case study in Washington State.

The movement of childbirth to the hospital in the early 1900s and the eventual establishments of health insurance reimbursement for hospital birth--but not for homebirth--solidified and reflected physician dominance in the area of obstetrics. Until recently, it was rare that a health insurer or a health maintenance organization (HMO) would cover a homebirth. However, in Washington State the majority of health insurance groups cover homebirths, which are generally attended by licensed midwives. In this context, our research is a case study focused on answering the question: What are the forces promoting the extensive coverage of homebirth by health insurers in Washington State? Data were gathered primarily through fourteen (14) in-depth, audiotaped interviews with key informants in relevant agencies and organizations in the state (i.e., state offices; midwife and other professional associations; and health insurance groups). Results suggest that consumer demand was an important precipitating factor without which changes to health insurance coverage would likely not have been made. Additionally, changes in state policies and professional mobilization on the part of licensed midwives were critical factors facilitating the widespread reimbursement for homebirth. Health care organizations' concerns for cost containment had little impact on this health insurance trend. Our study concludes that jurisdictional openings in the system of professions can be facilitated by a small number of strategically positioned individuals.

Adult↗
PubMed1997

Nurse practitioner center expands access to primary care.

In response to a need for increased patient access to primary care services in an area with a shortage of primary care physicians, not-for-profit Oconee Memorial Hospital, Seneca, South Carolina, opened a primary care center staffed solely by nurse practitioners. In addition to reducing the number of patients using the hospital's emergency room for nonurgent care, the center has improved patients' access to primary care services, strengthened the community's primary care base, and helped the hospital's managed care network win contracts.

Capital Expenditures↗
PubMed2003

[Effects of nursing insurance on caregiving daughters--the role of professional nursing care].

In view of the demographic development the topic of "Nursing of elderly relatives" is gaining more and more importance within nursing research. The object of the investigation described in this paper was to assess the measures of the Pflegeversicherung [Long Term Care Insurance] with regard to its effects on care-giving daughters. This publication assesses one of the questions of the study--what part professional services play in the support of care-giving daughters. The data was collected by individual biographic-narrative interviews in the private household of care-giving daughters. The data was then evaluated according to the method of biographical case reconstruction developed by Gabriele Rosenthal. This way we were able to gain a deeper insight into the situation of care-giving daughters and analyse the consequences of the Pflegeversicherungsgesetz [Long Term Care Insurance Law] from an "inner perspective". The results of the study point to both the positive effects of the Pflegeversicherungsgesetz and its limits. We were able to show that the expansion of out patient services leads to an enhanced nursing infrastructure. In view of the part that professional nursing services play, however, the biographical access also made it clear that the Pflegeversicherung will not lead to far-reaching changes in nursing arrangements. In spite of Pflegeversicherung caregiving relatives still suffer from personal and emotional strain. Also the legal requirements are too narrow and allow hardly enough space for the consideration of the family environment and the history of life of relationship between daughter and mother.

Adult Children↗
PubMed1990

The cost-effectiveness of nurse practitioners.

The use of nurse practitioners and other non-physician health care professionals is a cost-effective means of providing health care services. Since NPs, PAs, CNMs and others provide services comparable to physicians, their use in ambulatory care settings can also significantly increase the availability and accessibility to health care services, especially to low-income individuals and those requiring services in areas of physician shortage. While current obstacles such as reimbursement policies, legislative restrictions and prescriptive authority limit the use and effectiveness of non-physician health care providers, more physicians, hospitals, clinics, HMOs and public health care systems will view their use as a means of containing escalating health care costs. To the patient this will mean an increase in the availability of comprehensive health care services and the prevention and early detection of medical problems through wellness care. A discussion is presented regarding the ways in which use of NPs and other non-physician professionals can reduce costs and increase the quality and availability of health care services.

Attitude of Health Personnel↗
PubMed1993

Third-party payor billing and reimbursement for nursing services: infant apnea management.

This article examines the process of implementing a program for billing third-party payors for the services of the pediatric clinical nurse specialist. Factors to consider when initiating a billing program are discussed, as well as guidelines for structuring the charges, obstacles to reimbursement and strategies to overcome them, and benefits (both direct and indirect) of implementing such a program. Examples are cited from apnea management programs at two major children's hospitals in the southwestern United States. Implications are made regarding generalizing these methods to other nursing services and practices.

Apnea↗
PubMed1998

Reimbursement for nurse practitioner services.

Whether a nurse practitioner (NP) is employed by a medical practice or is self-employed, the reimbursement policies of third-party payers will determine whether an NP continues to provide care on a long-term basis. The payers--Medicare, Medicaid, indemnity insurers, and managed care organizations--each have their own reimbursement policies and fee schedules, and each operates under a separate body of law. Some payers have a history of reimbursing for NP services in the same manner as they reimburse for physician services. On the other hand, some payers have recently begun to reimburse NPs directly, either as separate and apart from an employment relationship with a physician practice or following NP-specific rules and policies regarding reimbursement. This article offers basic information necessary to communicate with practice managers, billing experts, and the payers about reimbursement mechanisms and problems. It covers how to set up provider relationships with the various payers, how to submit bills, and how to deal with denial of reimbursement when it occurs.

Forms and Records Control↗
PubMedDate not supplied

Direct reimbursement of nurse practitioners in health insurance plans of research universities.

The purpose of this study was to explore the nature of health insurance coverage research universities offer their employees and the extent to which these employers offer options providing for reimbursement of services of independent nurse practitioners. A request for health insurance documents mailed to 77 public research universities resulted in a response rate of 83 per cent. A total of 75 per cent sent usable descriptions of insurance coverage for analysis. Among the respondents, 69 per cent (n = 40) reported offering insurance through Blue Cross/Blue Shield companies. Nursing services reimbursed generally included traditional nursing care such as private duty nursing and home health care. Coverage of nursing services that overlap with traditional medical practice, such as prenatal care and labor and delivery services of nurse midwives, anesthesia services of nurse anesthetists, psychiatric services of nurse specialists, and primary care nursing services of nurse practitioners, was less evident. Findings generally indicated that in spite of the presence of enabling or mandatory state legislation for third-party reimbursement of nursing services, legislation is not being implemented in many states by employers in their purchase of group policies.

Data Collection↗
PubMed1992

Medicare program; fee schedules for the services of certified registered nurse anesthetists--HCFA. Final rule.

We are revising the Medicare regulations to allow certified registered nurse anesthetists (CRNAs) to receive Medicare payment for the anesthesia services and related care they furnish. In addition, this final rule sets forth the fee schedules under which payment is made for the services of CRNAs, except for the services of CRNAs in certain rural hospitals who are paid on a reasonable cost basis. This rule, which is effective for services furnished on or after January 1, 1989, implements section 9320 of the Omnibus Budget Reconciliation Act of 1986, as amended by section 4084 of the Omnibus Budget Reconciliation Act of 1987, section 411(i)(3) of the Medicare Catastrophic Coverage Act of 1988, section 608(c) of the Family Support Act of 1988, and sections 6106, 6107 and 6132 of the Omnibus Budget Reconciliation Act of 1989. This final rule does not reflect the changes concerning the calculation of payment rates contained in section 1833(1)(4) of the Social Security Act, as enacted by section 4160 of the Omnibus Budget Reconciliation Act of 1990. Those changes apply to services furnished on or after January 1, 1991. Thus, the changes to the payment calculation provisions described and published below are applicable only to services furnished in calendar years 1989 and 1990.

Certification↗
PubMed2004

EPSDT & billing.

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Adolescent↗