Medicaid Reimbursement for ARNP (Advanced Registered Nurse Practitioner) services
Florida Medicaid reimburses for services rendered by licensed, Medicaid-participating Advanced Registered Nurse Practitioners (ARNPs). The services must be rendered in collaboration with a physician. Reimbursement for anesthesia, obstetrical and psychiatric services is limited to ARNPs who have completed the educational program in the appropriate specialty and are authorized to provide these services.
Medicaid reimburses ARNPs who are Medicaid-participating independent providers with formal relationships with Florida licensed physicians.
LIMITATIONS:
Medicaid reimbursement for ARNP services is limited to:
• One ARNP-recipient contact per day (except for emergencies);
• One long-term care facility service, per ARNP, per month, per recipient (except for emergencies);
• Ten low-risk prenatal and two postpartum visits per pregnancy; and
• One new patient evaluation and management service, per ARNP, per recipient, every three years, if no services were rendered by the ARNP to the recipient during the three years. Subsequent encounters must be reimbursed as established patient evaluation and management services.
EXCEPTIONS:
The ARNP may request authorization for reimbursement for services in excess of the service limitations.
ELIGIBILITY:
Medicaid reimburses for ARNP services for all Medicaid recipients based on medical necessity.
REIMBURSEMENT:
Medicaid reimbursement for ARNP services is the maximum Medicaid fee or the provider’s customary fee, whichever is lower. ARNPs are reimbursed at 80 percent of the physician’s rate for services that are approved by the Centers for Medicare and Medicaid Services (CMS), formerly known as HCFA. If an ARNP is salaried by a hospital or other facility that is reimbursed on a cost-related basis, the ARNP cannot be paid on a fee-for-service basis if the costs for the ARNP’s salary are included in the facility’s cost report.
There is a $2 recipient copayment for ARNP services, per provider, per day, unless the recipient is exempt.
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
Therapeutic activities are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve ...
-
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defi...
-
AAPC’s Certified Professional Coder (CPC) credential is the gold standard for medical coding in physician office settings and held by more ...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
Claim Adjustment Reason Codes (CARC) CO-22 or PR-22 This care may be covered by another payer per coordination of benefits. CO-19 This is...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
A bacterial urine culture is a laboratory procedure performed on a urine specimen to establish the probable etiology of a presumed urina...
-
Effective for claims processed with dates of service (DOS) on or after January 1, 2018, influenza virus vaccine code 90756 (Influenza v...