As NPs push for autonomy, they aren’t just challenging the scope of practice limitations and required physician oversight. They are also having to maneuver receiving lesser reimbursement rates than their physician colleagues despite providing equivalent care. Medicare states it rather plainly. If NPs bill services performed outside of a hospital, they will either be reimbursed for 80% of what they billed or 85% of what a physician would receive for completing that service.
Although NPs continue to advocate for equal pay alongside physicians, it is a complex process that requires taking small steps for long-term effects.
“Incident To” Billing
As part of Medicare’s reimbursement policy, they use an “incident to” structure that has shown to have its benefits and challenges regarding the NP’s professional development and career.
Under “incident to,” billing is done under a physician’s name for 100% of that physician’s fee. For those running a practice, it’s a preferred way of billing due to the higher reimbursement rate, but NPs are having to make sacrifices to function under this structure.
When services are billed under the physician’s name, it reduces the transparency of just how much an NP contributed to a patient’s care. It also makes it more difficult for NPs to track how NPs positively affect their patients as credit is going to the physician. This creates a cycle of positive reinforcement. The data will show that physicians are providing optimal care for patients, supporting their efforts, and encouraging their careers. Meanwhile, NPs continue to face claims that they provide lesser quality care than physicians, and under “incident to” billing, it is difficult to prove the NP’s contribution.
Hindering Growth and Overall Care
Even when NPs practice in full authority states, only 56.4% will bill under themselves rather than a physician. While there may be several reasons for this decision, the financial disparity between NPs and physicians also suggests that billing under NP might hinder the growth of NP-led practices.
While NPs have less capital to expand their practices, physicians have a competitive edge. With higher reimbursement rates, they can expand their practice to support more patients with diverse needs. More patients receiving quality care is always a benefit, but it’s not a sustainable burden to place solely on physicians, especially as we are currently seeing a physician shortage. Granting NPs the resources to expand care supports their professional growth while also increasing patient access to care they might not otherwise have.
Taking Control
Although the circumstances seem bleak for NP compensation, here are a few ways that NPs can take control.
- Advocacy with Direct Billing: If feasible for your practice, consider opting for direct billing to ensure patient outcomes provided by NPs are reflected accurately in patient data. Although the pay is less, the growing positive outcomes under NP services can serve as evidence for future reimbursement reform in the long term.
- Stronger in Numbers: NPs can research and join advocacy groups to support lobbying efforts prioritizing NP autonomy and reimbursement reform. Staying informed and active within the cause can lead to substantial change.
- Alternative Practice Models: Explore new approaches to patient care, such as value-based care or telehealth services. These models can offer more flexibility in how NPs deliver care, helping NPs have more opportunities to bill directly while still functioning competitively within the healthcare sector.
The Way Forward
NPs are currently navigating a complex landscape where reimbursement policies are working against them. Despite the higher payments through “incident to” billing, it compromises care transparency and limits how NPs can prove their impact on patient care. Through direct billing, advocacy efforts, and exploring alternative practice models like telehealth, NPs can take proactive steps toward reimbursement reform and professional recognition.
