Nursing

 key barriers for nurse practitioner with commercial prayers

 ANSWER

Nurse Practitioner

Key barriers for NP’s credentialing with commercial payers

Credentialing is considered as the process that entails established guidelines used to confirm that the nurse practitioner possesses licensure, qualifications, training and abilities to practice (McMullen and Howie, 2020). One of the most significant barriers is the variation in credentialing by the health care agencies. Health insurance covers vary depeding on the state policies and laws. For instance, NP practice in one state may vary, and thus the insurance policies vary. Relatively, there are insurance payers that do not recognize nurse practitioners as primary care providers. Another issue is that few states allow credentialing of NPs directly. A particular insurance company may not credential a Nurse practitioner unless the collaborating physician is credentialed with the commercial payer.  Most commercial payers are not up to date with the NPS practices and information, which makes credentialing a daunting process.

Value of NP quality and efficacy data in commercial insurance negotiations and appeals.

NP quality and efficacy data play a significant role in the commercial insurance negotiations since they demonstrate competency and quality measures of the nurse practitioner practice. The productivity data offer the Nurse practitioners with practice statistics to be used in negotiations with insurance companies. Ideally, the productivity data is an additional benefit to determine the worth of service they offer (Dillon and Gary, 2017). For instance, efficacy data that illustrates efficiencies that lower costs and cost-effective healthcare can be sufficient in negotiating in the contract since the payers consider the quality of care to reduce hospital re-admissions. When the insurance payer is offered organized and well-documented data analysis, they can identify the value that NP’s practice brings to the members.

Commercial payer barriers with telehealth.

A significant barrier has been the lack of consumer awareness and education that the telehealth is an effective alternative to receiving services through their insurance plan (Rogove, McArthur, Demaerschalk, and Vespa, 2012). The state requirements of credentialing and licensing telehealth providers have varied considerably. States require the health care providers that offer the patient services to be licensed. However, providers may fail to pursue a license in varying states due to the high costs.

References

Dillon, D., & Gary, F. (2017). Full practice authority for nurse practitioners. Nursing administration quarterly, 41(1), 86-93.

Rogove, H. J., McArthur, D., Demaerschalk, B. M., & Vespa, P. M. (2012). Barriers to telemedicine: a survey of current users in acute care units. Telemedicine and e-Health, 18(1), 48-53.

McMullen, P. C., & Howie, W. O. (2020). Credentialing and Privileging: A Primer for Nurse Practitioners. The Journal for Nurse Practitioners, 16(2), 91-95.