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Medicaid
The United States’ health sector has various programs aimed at improving people’s medical outcomes, including Medicaid and Medicare. Medicaid is a joint state and federal program that supports Americans’ health needs. The key beneficiaries include all individuals whose resources and income are incapable of catering for their medical demands. Currently, the program offers health insurance to around 74 million citizens.
Most of them include children, expectant women, and disabled persons (Cubanski et al., 2015). The program covers a wide range of benefits, including dental healthcare, physician services, rural healthcare, nursing facility services, inpatient and outpatient hospital services, X-rays, nurse midwife services, pediatric care, and family planning. Optional services include prescription drugs, respiratory care, physical therapy, case management, hospice, and eyeglasses.
Some states in the country can impose co-pays and deductibles on a number of Medicaid-covered services or benefits. Co-pays are fixed mandatory amounts that patients should pay whenever using their Medicaid plans (The National Association of Pediatric Nurse Practitioners, 2016). Deductibles are amounts paid by individuals out-of-pocket annually before receiving medical covers. These costs apply to specific beneficiaries of Medicaid not exempted by existing state laws.
This discussion means that policymakers should consider different factors whenever reimbursing NP services. Currently, the payment ratio for NPs is 85 percent of the existing physician rate. Cubanski et al. (2015) indicate that the proficiency and expertise of NPs is the first issue to consider. Practitioners should also demonstrate financial outcomes in order to promote positive changes in reimbursement rules.
The fact that NP services have to be billed under physicians’ explains why the care provided by different practitioners remains invisible. Documentation by physicians is another critical issue to take seriously in the Medicaid reimbursement of NP services. Split billing when NPs co-manage patients with physicians is also an important factor to consider.
Medicare
The second program aimed at meeting the health needs of American citizens is Medicare. This is a single-payer medical insurance plan managed by the Centers for Medicare and Medicaid Services (“Medicare,” n.d.). This federal program covers individuals above the age of 65, young persons with certain disabilities, and those suffering from End-Stage Renal Disease. Citizens with this kidney condition usually require either a transplant or dialysis (usually called ESRD).
This program currently provides medical insurance to around 55 million citizens. The program usually covers half of the health expenses the targeted enrollees incur. Co-pays and deductibles also amount to the out-of-pocket costs for medical services.
The program is divided into several parts, including Part A and Part B. The first one caters for hospice care, inpatient hospital expenses (or stays), or services offered in nursing facilities. The allowed length of admission for inpatient stay is 90 days. This type also covers short stays for convalescence or rehabilitation in nursing facilities. Co-pays are allowed if specific criteria are fulfilled. Part B is aimed at covering expenses that are not supported under Part A. These include medical supplies, outpatient care, certain physicians’ services, and preventive services (Cubanski et al., 2015). This type caters for durable medical equipment (DME) to support the needs of patients with mobility impairments. Some of them include wheelchairs, walkers, canes, and lift chairs.
Just like in Medicaid reimbursement of services, policymakers should consider various factors in order to support the goals of different practitioners. For instance, the quantity and quality of services delivered to different patients is something that should be taken seriously (The National Association of Pediatric Nurse Practitioners, 2016). Comprehensive documentation will also ensure that the measurement for every NP’s contribution is standardized. These issues will empower more NPs to continue providing high-quality medical services.
References
Cubanski, J., Swoope, C., Boccuti, C., Jacobson, G., Casillas, G., Griffin, S., & Neuman, T. (2015). A primer on Medicare: Key facts about the Medicare program and the people it covers. Web.
Medicare. (n.d.). Web.
The National Association of Pediatric Nurse Practitioners. (2016). Position statement on reimbursement for nurse practitioner services. Journal of Pediatrics and Health Care, 30, A17-A18. Web.
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