Billing For Nurse Practitioner Services: Guidelines for NPs, Physicians, Employers, and Insurers

Carolyn Buppert, NP, JD


January 31, 2002

In This Article

Conclusion: Why the Law on NPs is So Complicated

There are several explanations for the complicated and varied law on NPs:

  1. The Federal government frequently defers to state law regarding NPs. Some states' law on NPs was enacted in the 1970s. Other states' law on NPs is brand new. Each of the 50 states has its own brand of legislators, governor, lobbyists, medical associations, and nursing associations that influence legal language and process.

  2. The wide array of patient needs, providers, and payers in today's healthcare industry make for continually evolving delivery systems and practice arrangements. Providers find that their specific situation is not addressed in the rules, and frequently call upon the government to issue new rules to address questions that arise. Rules proliferate.

  3. Much of federal law, such as the law governing hospitals and nursing homes, was enacted when NPs were not as prevalent or well known as they are today. The word "physician" was used traditionally throughout the United States Code, as, until 30 years ago, no other professional performed medical services. So, to authorize NPs to perform some physician services, each section of the code and regulations has to be changed to broaden the language from "physician" to "physician and other authorized provider" or to "physician, nurse practitioner, clinical nurse specialist, and physician assistant." Such changes take time to draft, disseminate, and discuss, and do not come about unless there is a proponent for change, and unless the proponent is more persuasive than any opponents to change.


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