Nurses Receive Lower Medicare And Medicaid Reimbursement Returns Compared To Physicians

Nurses Receive Lower Medicare And Medicaid Reimbursement Returns Compared To Physicians

by from Medelita | Friday, May 13, 2016

Physicians and nurse practitioners share many job functions, including diagnosing, treating, and manage acute and chronic diseases, ordering and interpreting labs and diagnostic tests, and prescribing medications (in most states). However, when it comes to Medicare and Medicaid reimbursement returns, rates for nurses are, for the most part, far below the average reimbursement returns for a physician, according to MidLevelU.

Both Medicare and Medicaid are government-managed programs that calculate physician reimbursement rates based on a fee schedule. They differ in the fact that Medicare is a federally provided program with a fixed rate, and Medicaid is a joint federal and state program with rates that vary depending on the state.

Medicare provides health coverage to individuals who are 65 years or older and for individuals who have a severe disabilities. Depending on the type of visit and Medicare patient (whether they are first time patients, members of the clinic, have their own insurance provider, et cetera) dictates how much a physician and nurse practitioner will get for reimbursement for that patient.

Nurse practitioners are reimbursed by Medicare at a rate of 85% compared to physicians. So, for every case where a physician would receive $100 reimbursement, Medicare would pay $85 to a nurse practitioner.

Medicaid on the other hand is a bit more complex in that it helps with medical costs for some people with limited income and resources. For nurse practitioners, that means that their reimbursement rates vary anywhere from 75% to 100% of the physician rate depending on the state. While some states actually reimburse NPs at 100% the rate of MDs, there are many cases where doctors earn a substantial amount more in reimbursement revenue than nurse practitioners.

The Medicare-to-Medicaid Fee Index is a list of index rates for each state and can be found here.