Which Pays More Nurse Pratitioner Or Registered Nurse

Y'all may take entered nursing with the purest of intentions, seeking a career of service. Helping people is your affair. But, let's be honest. Your do must generate revenue to stay in business. Y'all can't help your patients go healthier or treat their medical problems without being reimbursed for your time and resources. Taking into account the dollars and cents of the services you provide as a nurse practitioner is essential to keeping your practise adrift. Which regime-based insurance plans reimburse NPs at the highest rates?

I mentioned earlier this week that looking at nurse practitioner reimbursement rates gets gluey. The amount nurse practitioners are paid by entities similar Medicare and Medicaid is calculated based on md reimbursement rates. Then, it is necessary to look at both MDs and NPs in considering the financials behind treating Medicare and Medicaid patients as an NP.

How is nurse practitioner reimbursement calculated by Medicare?

Medicare reimburses physicians a set amount for services provided (Run into hither and hither for a more detailed explanation of how rates are set). Nurse practitioners are reimbursed by Medicare at 85% the charge per unit of physicians. And so, if a doctor provides services to a patient Medicare deems worthy of a $100 reimbursement, the NP would exist reimbursed $85 for providing the same care (a technicality can assist your practice circumvent lower reimbursement rates).

How is nurse practitioner reimbursement calculated by Medicaid?

Are You Fix to Thrive?

Learn more about our online residency plan; we pair clinical and professional development to accept advanced practice providers to the next level. Get More than Info>>

Decisions regarding nurse practitioner reimbursement compared to that of physicians for Medicaid are made at the state rather than federal level. Then, nurse practitioner reimbursement for services provided to patients varies past state.

States reimburse nurse practitioners at anywhere from 75% to 100% of the doctor rate. This means that unlike Medicare, some state Medicaid plans treat services provided by nurse practitioners every bit to those provided by physicians. In fact, most states reimburse NPs at 100% the rate of MDs. The Kaiser Family Foundation has published a helpful table outlining Medicaid benefits in regards to nurse practitioners including reimbursement rates.

How practise Medicare and Medicaid medico reimbursement rates compare?

Since states prepare their ain rates at which they reimburse providers, where you practice makes a difference. In some states, providers stand to turn a profit virtually by treating patients insured through Medicare. In other states, treating patients insured through Medicaid plans generates the most acquirement. Alaska'due south Medicaid physician reimbursement rate, for case, is 124% that of Medicare'due south. California, in contrast, reimburses at a charge per unit merely 51% of Medicare's making encounters with Medicaid patients far less profitable.On average, states reimburse physicians at a rate near 66% that of Medicare.

The relationship betwixt state Medicaid and Medicare physician reimbursement rates is represented by the Medicare-to-Medicaid Fee Index. A list of index rates by state tin exist found here.

How do Medicare and Medicaid NP reimbursement rates compare?

Here's where calculations get messy. The rate at which a doctor is reimbursed by Medicaid as well every bit the rate at which a land's Medicaid plans reimburse NPs come into play. To determine if you stand to generate more revenue as a nurse practitioner by treating Medicare or Medicaid patients in you land, consider a theoretical scenario where Medicare would reimburse the physician $100 for services provided. Complete the post-obit calculations:

1. Based on physician reimbursement, make up one's mind the amount you would exist paid as a nurse practitioner by Medicare

If a physician provides services to a patient Medicare values at a $100 reimbursement, the NP would be reimbursed $85 for providing the same care.

two. Summate theamount you would be paid equally a nurse practitioner by Medicaid in your country

The post-obit example considers a nurse practitioner practicing in Indiana. Nurse practitioners in Indiana are reimbursed at 75% the rate of physicians by the country's Medicaid plans. The Medicare/Medicaid Fee Index (based on physician reimbursement rates) in Indiana is 0.62.

So, based on this calculation, the nurse practitioner would be reimbursed $46.50 by Medicaid for services provided.

Notation: Medicaid-to-Medicare Fee Alphabetize lists values by state. Medicaid reimbursement rates for nurse practitioners compared to physicians tin can be found hither.

3. Analyze your results

Based on the example above, a scenario in which the NP practices in Indiana, the nurse practitioner would generate the following amount of revenue:

Medicare – $85
Medicaid – $46.fifty

While the scenario these calculations are based upon is theoretical, information technology serves equally a visual for assessing Medicare and Medicaid reimbursement rates as a nurse practitioner.

Implications for Your Practice

Crisis the numbersrelated to nurse practitioner reimbursement in the country in which you practice. How does the revenue you stand to generate compare for patients insured by Medicare vs. Medicaid?

While these calculations may or may not affect the types of patients yous treat in your exercise or motivate an reassessment of your exercise'due south business program, it is of import for nurse practitioners to maintain an awareness of how and how much they are paid.

Are nurse practitioner reimbursement rates more favorable for Medicare or Medicaid in your country?

Yous Might Besides Like: 5 Issues to Consider in Starting Your Ain Nurse Practitioner Exercise