Introduction

	Key Reasons APN's Must be Knowledgeable About Reimbursement
What Nurses Are Saying: In a recent study of barriers to APN practice by Lindeke & Chesney (1998), nurses stated: "(Reimbursement) was not covered at all in school. I have learned vast amounts since being out on my own regarding types of plans/systems." "More information would be helpful to best utilize the system for my patients." "I need to become more knowledgeable of the insurance system so I will know how it is setting up barriers for me." "If I knew more, I could play the game." SO…you can see that nurses in practice want to increase their knowledge of reimbursement...
	Keep on going in this module! The importance of this topic will soon be apparent to you. Links to other web sites will help you understand some of the issues. Don't get distracted on these sites-just review them briefly, bookmark the ones of interest, and then come back to this module to learn more.

Sobering Facts About Reimbursement

Fraud Issues	Medicare Issues	Healthcare Issues
Health care providers found guilty of fraud can be ordered to pay reimbursement fees with interest as well as fines to payers. If found guilty of intentional fraud criminal penalties can be added. Click HERE to view a government site which monitors Medicare fraud.	Medicare fraud is being called the "crime of the 1990's" and is a high priority issue for the U.S. Justice Department.	Health care reform efforts begun in the early 1990's that introduced managed competition have not resulted in cost containment. Escalating U.S. health care costs makes reimbursement of all health care providers a political and economic issue: U.S. health costs in 1965 - $42 billion (5.9% of Gross National Product) U.S. health costs in 1990 - $647 billion (12.5% of Gross National Product) Administrative costs of U.S. health care system are high (20-25%), compared to other industrialized countries (i.e., Canadian health care administrative costs are 10%).

Visit the excellent Web site of the American Academy of Nurse Practitioners for background information, directions on obtaining a provider number, and periodic updates at http://www.aanp.org/medicare.htm