Effect Of Medicare/Medicaid Reimbursement On Advanced Practice Nurse

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Effect of Medicare/Medicaid Reimbursement on Advanced Practice Nurse

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Effect of Medicare/Medicaid Reimbursement on Advanced Practice Nurse

Thesis Statement

The effect of Medicare and Medicaid reimbursement on APN (Advanced Practice Nurse) and what are the regulations which the APNs must be have knowledge about is a matter to put light on.


"Sickness" is what is happening to the patient. Listen to him. Disease is what is happening to science and to populations. (Weed, 1978, p. 205)

Nursing is a noble profession, and everyone in this world knows this, but if we see back in the history, things were not the same as they are right now. Professional Nursing was not considered to be a good profession to pursue your career in, as people had a mind set about nursing that it is not a noble profession and one should not be taking it as a career. It all changes when one of the famous personalities from the history, as we all know many of them like, Margaret Sanger, Clara Barton and the most famous, Florence Nightingale joined this noble profession of professional nursing. She is the founder of what we refer to as professional nursing now. A person like her from a highly esteemed family joined this profession and proved to the world that helping people and caring for them is the best profession in the world. She is most famous for her efforts to reform the British military health system (Hebert E., 2007). Nursing means to care for the mankind it can be referred to as helping people regardless to any age, gender and nationality and only promotes to health, care of ill, prevention of illness, dying people and disabled ones.

In this essay the effect of Medicare/Medicaid reimbursement on Advanced Practice Nurse has been discussed and some issues and most common policies and regulations have been discussed.


To cover health care services, the current federal law of United States provided by some APNs which includes family nurse practitioners, pediatric nurse practitioners and certified nurse midwives. In some states there have been services of certified registered nurse anesthetists and specialists of clinical nurse that is because in physician shortage areas, these practitioners are good and willing to provide the services which are in need to the patients.

It has been encouraged by The Balanced Budget Act of 1997; states are allowed to use in the fee for service program, primary care case managers as care managers as gatekeepers. The BBA (Balanced Budget Act) had granted to recognize pediatric nurse practitioners the option to recognize, certified nurse midwives, family nurse practitioners as primary care case managers; as well as they have option to refuse these providers.

To move into managed care, the BBA urged to move the states their Medicaid population. Only a very vague reference has been provided by this law to the types of providers that in manages care panels must be included. The plans should show only that they provide sufficient number geographic distribution and mix providers. In primary care case managed and management ...
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