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ADVANCE Perspective: Nurses

Medicare to Reimburse Advanced Practice Nurses for ‘Care Coordination'

Published November 16, 2012 8:48 AM by Linda Jones

A news release from the American Nurses Association (ANA) explained a new Medicare rule that will pay advanced practice RNs for the work they do to manage patients' transitions from hospitals to other settings and to prevent complications and conditions that cause hospital re-admissions.

The rule creates new payment codes for "care coordination" activities performed by RNs that reduce costs and improve patient outcomes. The result is an increased likelihood of direct reimbursement for these services and potentially creating more RN jobs to fill this need.

"The American Nurses Association has been advocating for years that government and private insurers need to recognize nurses' contributions to transitional care and care coordination and pay appropriately for these essential services," said ANA President Karen A. Daley, PhD, MPH, RN, FAAN. "This Medicare rule is a giant step forward for nurses whose knowledge and skills play major roles in patients' satisfaction and quality of care."

New payments will be awarded to nurse practitioners, clinical nurse specialists, certified nurse midwives, and other primary care professionals for "transitional care management" services provided within 30 days of a Medicare patient's discharge from a hospital or similar facility. To qualify for reimbursement, the primary care professional must: contact the patient soon after discharge; conduct an in-person visit; engage in medical decision-making; and provide care coordination. Care coordination involves effectively communicating and delivering a patient's needs and preferences for health services and information among a continuum of health care providers, functions and settings, according to the ANA release.

The Medicare Physician Fee Schedule Final Rule, issued Nov. 1 by CMS and set to take effect Jan. 1, 2013, also includes new codes that describe "complex chronic care coordination," a service typically provided by RNs. Though the rule will not allow separate billing for care coordination, some private insurers are likely to use the codes to reimburse providers directly for the service, stated ANA.

posted by Linda Jones


Excellent move in the right direction for patients and families!

Linda Tieman, Nursing Workforce - Ex Director, WCN November 26, 2012 7:14 PM
Tukwila WA

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