Hi, my name is Laurie Jeffers and I would like to talk to you today about Medicare reimbursement for advanced practice nurses. I'm currently a student in the doctoral program at Duke University's School of Nursing. I graduated from Duke in 1982 with a Bachelor of Science in nursing degree. I've been a nurse for over 30 years in a variety of settings, the last 15 of which have been spent as a board-certified family nurse practitioner. For the last 11 years, I've had my own practice called Well Woman Care, where I focus on the preventive needs of women across a variety of ages and stages of life. My youngest patient is 9 and my oldest patient is 92. I have about 700 patients that I take care of. I became a Medicare provider under my own NPI (national provider identifier) when I started my practice in 2002. Under Medicare guidelines, different categories of APRN (advanced practice registered nurse) providers are recognized. These include nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and clinical nurse specialists. Our Duke DNP (Doctor of Nursing Practice) program consists of many of these professionals. In fact, I'm very proud to be in this program among the best of the best of these clinicians. Together, we represent over 267,000 nurses in advanced practice across the country, and together we use our highly skilled expertise to take care of thousands of patients on a daily basis. Every day, we put thousands of patients safely under anesthesia, and every day we treat and manage thousands of patients with chronic illnesses such as hypertension, diabetes, asthma, and a variety of other conditions through our practice in primary care settings. Every day, hundreds of infants are safely delivered by certified nurse midwives, while clinical nurse specialists play an important...
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Medicare reimbursement Form: What You Should Know
Paying Claims. Medicare does not pay for a claim when: A claim is filed without an itemized bill from your doctor. 4. Claims in the Small Claims or Supreme Court (Court of Appeals) court. If your claim is for less than 50,000 or 1,000,000, Medicare will not pay. 5. Claims submitted in excess of 50,000 or 1,000,000 for benefits below the Part B maximum. If your claim is for benefits above the Part B maximum, submit your Part B Claim or Medicare claims forms in person with a certified letter (for your claim) from your doctor stating how much you paid for coverage you received and why you believe your payment was appropriate. Include your Medicare account number; if you are filing for disability benefits, your Part B Social Security number. 6. Median policies. If you meet the income guidelines for the tax-favored Median policy of your insurance company, Medicare may cover all of your Median expenses. Learn more in Medicare's Median Policy Coverage Guidelines. 7. Claims submitted in excess of 150,000 for benefits below the Part B maximum with respect to Part A and the Medicare Part B premiums You may also wish to see if you are eligible for the following: Get more information on the Median Policy. You must file a Part B claim if your Part A or B premium exceeds 1,000.00 for Part A and you paid over 150,000 in premiums for Part A and your Part B premium is 50.00 or higher. However, you will be eligible for Median insurance coverage and will receive reduced Part B premiums. To view the Medicare Part B premium schedule and/or the Median Policy, click or tap the following link: Part B Premium Schedule Important information is available in the Median Policy FAQ on the Medicare website. 1. Medicare will provide cash benefits on your Part A and Part B premiums. (See Chapter 21) 2. If you have an income above the Part D income limit, you must apply for the reduced Part B premium. The Part A premium applies to the premium you paid for your Part B coverage that was paid for by Part D health plan premiums.
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