Questions From The Membership

How Does Our New PCP Legislation Affect My Practice?

10/31/2008

1) Does this new law mean I do not have to have a physician supervise me anymore?

No, this law does not change the collaborative relationship required by law, nor does it change the supervision requirement for prescriptive practice. What it does is require insurance carriers with whom you are a participating provider to list you as a Primary care provider. This gives patients an option to choose an NP to be their PCP and direct their care.

2) Do I get more reimbursement under the new law?

This law (Chapter 305) does not change the reimbursement an NP receives nor does it change the lines of reimbursement. For instance, you are hired by a doctor or practice to work for them and they pay you a salary or per visit rate. The office bills for your services and you have assigned the payment to the practice. In most instances you receive 85% of the physician fee schedule for your work. The payment goes to the practice. Neither the lines of reimbursement change nor the amount you will be paid because of Chapter 305.

3) Do all insurers have to credential me?

No, Chapter 305 is not "any willing provider" language, meaning it does not require insurance companies to contract with all NPs. Under this law, if you are a "participating provider" with an insurer, meaning they pay for your services under a contract with you, your agency or your collaborating MD, they must list you as a PCP choice for patients. It does not mean they have to credential all NPs and does not force them to contract with all NPs. Chapter 305 does, however, make us visible to patients and gives us PCP status within insurance plans with whom we currently contract.

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Nancy O'Rourke, MSN, ACNP, ANP, RnC.
AANP State Representative and President Massachusetts Coalition of Nurse Practitioners