The Complexity Involving Medicare Different Rate Reimbursement for NPs and MDs

Historically, the insurance carriers mostly have paid regular fees; however, Medicare reimbursement is not the same for Nursing Practitioners (NPs) and Medical Doctors (MDs). In the Medicare fees, only 85% of the standard prices are catered for regarding NPs, while on the other hand, the MDs receive 100% (Phillips, 2019). Physician Assistants (PAs) use the rule since they can choose the billing type while they are in the office under a supervising physician. Through this technique, they access the full amount of Medicare allowable fee instead of the standard rate. The rates were effected in 1998 by Congress and signed by the president and have remained generally untouched to date (Medicare Payment Advisory Commission, 2019). However, the NP’s role has transformed tremendously, raising concerns about the policy’s validity. The question of fairness regarding insurance carriers’ payment amount is complicated because of the various logistics involved, such as quality of care and workload.

Congress changing the reimbursement policy considers different factors in assessing the need for equity of the different rates. These include the time the two spend with their patients and whose time is more useful than the others. Another consideration should be the measure of workload and the complexity of the case under examination. Moreover, the economic sense should be assessed, which recognizes the level of access to healthcare. The rates should not be changed because of the results of evaluating the criteria made above. The primary guiding principle is that it is easier to prevent illnesses than to treat them, especially financially. Unlike their counterparts, PAs provide more economical care, mostly involved in managing diseases (Medicare Payment Advisory Commission, 2019). The ideology negates the time spent with a patient since the supervising physician is always in a rush to attend to all the patients scheduled for that particular time. The Complexity Involving Medicare Different Rate Reimbursement for NPs and MDs


The solution to the disproportionate payment rates involves political agencies that can design proposals for a policy change. It is a large-scale concern that will include several players on many levels. The nurses and other independent firms are primarily the practitioners that are opposed to the current policy. The private firms will make more money by employing more nurses than physicians, hence their need for equality. The NPS equally demands a policy change because some think it is unfair, and because the resulting overall salary is less (Phillips, 2019). The bill’s rejection was mainly due to the fear that the insurance companies may decrease MDs’ rates instead of increasing that of nurses (Medicare Payment Advisory Commission, 2019). The central bodies that can successfully prompt the need for change include federal organizations and state insurance commissioners.

The PA duties play a significant role in maintaining the desired change or vice versa. It is imperative to note that the policy change does not affect the tasks performed by each of the practitioners. Eliminating the billing of “incident to” does not offer any significant transition in how care is delivered to patients (Medicare Payment Advisory Commission, 2019). Additionally, the payment does not affect the state supervision and collaboration requirements. The only difference would be the amount payable by insurance carriers to the nurses. However, a direct billing that applies uniformly to NP and PAs could help Medicare set PFS care rates more accurately. Moreover, it can provide a suitable platform that allows policymakers to assess the costs delivered by each of the two. Eliminating the “incident to” billing also generates a program savings scenario, hence lower beneficiary cost-sharing.


Medicare Payment Advisory Commission. (2019). Improving Medicare’s payment policies for Advanced Practice Registered Nurses and Physician Assistants. MedPAC. Web.

Phillips, S. J. (2019). 31st Annual APRN legislative update: Improving state practice authority and access to care. The Nurse Practitioner Journal44(1), 27-55. Web. The Complexity Involving Medicare Different Rate Reimbursement for NPs and MDs

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