Nurse practitioners often work with physicians, within physician groups, or hire physicians so that they can receive 100% insurance reimbursement for their services. This is called “incident to” billing and indicates that the physician is somehow involved with the care of the nurse practitioner’s patients.
In many states in the U.S. nurse practitioners have autonomous practice and do not require physician involvement or presence within their practice. In performing identical services, such as a primary care visit for yearly physical exam, the nurse practitioner will only receive 75-85% compensation from Medicare, Medicaid, and private insurance companies.
85% is an arbitrary figure assigned to nurse practitioners. (Arbitrary means it was “random decision”, some may argue that it was an opportunistic decision as well.) The Medicare Payment Advisory Commission (MedPAC) examined this payment disparity and determined that there was “no specific analytic foundation” for paying nurse practitioners less than physicians for the same services. This creates nurse practitioner invisibility. This decreases nurse practitioner accountability for their own services, it looks as though the physician has responsibility. This creates a lack of transparency in the healthcare system…what you see on your insurance bill is not what you get…the physician’s name is hiding the actual provider’s name ===> the nurse practitioner.
Nurse practitioners must display a physicians name on prescriptions in many states without autonomous practice and/or prescriptive authority. The pharmacy will often list that physician as the official prescriber on the patient’s medicine label. The pharmacy that fills the prescription will often tell the insurance company that the physician wrote the prescription. Often, the physician has never, ever, met the patient.
This causes patient confusion and some patients will not even take the medicine because they don’t recognize the prescriber’s name on the label. Giving the insurance company the physician name rather than the nurse practitioner name is untrue & misleading. This makes nurse practitioners invisible. This decreases nurse practitioner accountability for their own services. This creates a lack of transparency in the healthcare system…the physician’s name is once again overshadowing the nurse practitioner’s name. This promotes & encourages inaccurate reporting.
How to to fix this?
Advocate for your nurse practitioner ===> Equal Reimbursement, Autonomous Practice, Prescriptive Authority. Contact your pharmacies, medical insurance companies, and your legislators!
Healthcare is NOT a competition. Nurse practitioners and physicians will always remain partners in patient care. Allowing patients the opportunity to CHOOSE the healthcare provider, is a way of promoting fairness and decreasing costs in the healthcare market.