[
As previously communicated, effective August 1, 2017, Independence updated
the following policies on reimbursing certified registered nurse practitioners
(CRNP) to include services performed in a specialist?s group:
- Commercial: #00.10.40a: Reimbursement for Services
Performed by Certified Registered Nurse Practitioners (CRNP)
- Medicare Advantage: #MA00.045a: Reimbursement for Services
Performed by Certified Registered Nurse Practitioners (CRNP)
Clarification to the policies
There are certain specialties to which these policies do NOT apply;
therefore, the following language was added to the policies on August 22,
2017:
This policy does not apply to hospital-based specialties
(e.g., hospitalist, emergency room, radiologist, neonatology) and urgent care
practices.
As per the policies, CRNPs who are working in a participating specialist?s
group may become credentialed as a participating provider.
Services performed on a fee-for-service basis by a CRNP will be reimbursed
based on the terms of their professional provider Agreement. Payment for
services rendered will be based on 85 percent of the standard physician fee
schedule.
For more information
To view these policies, visit our Medical Policy Portal. Select
Accept and Go to Medical Policy Online, and then select the
Commercial or Medicare Advantage tab from the top of the page and
type the policy name or number in the Search field.
]