Additional information on Aetna's new policy is available on page 4 here. The American Academy of Nurse Practitioners (AANP) sought feedback from NPs on this change for a formal statement. Tay Kopanos, NP, AANP director of healthcare policy for state government affairs, told ADVANCE that Aetna's June provider newsletter noted that NPs would still need to submit their claims as "incident to" physician services. Following is an interim statement from AANP by Kopanos:

The American Academy of Nurse Practitioners learned of Aetna's proposed nation-wide policy change on credentialing and reimbursing nurse practitioners in March. This change creates direct reimbursement for NP services, and primary care provider status in states that had not previously had this opportunity. This policy will reimburse nurse practitioners at 85% of the physician rate for the same services. This was an internal policy change at Aetna, and was not open to public comment from either the NP or broader provider communities.  AANP is evaluating how this will impact patient access to care, patient choice and NP employment, as well as NP autonomous practice viability.

 While this change is consistent with the AANP position that patients have access to their provider of choice, implications for patients and NP practice are still being evaluated.  For some nurse practitioners, the opportunity to credential as primary care providers will facilitate patient access to NP services at the primary care co-pay (instead of at the specialty level) and provide NPs with a new opportunity for insurance empanelment. For others there is concern that reimbursement at the Medicare rate of 85% or the continued utilization of Medicare "incident to" billing policies will limit the ability of NPs to see Aetna patients coming to their practice.

 In their June 2010 provider newsletter, Aetna clarified their policy on reimbursement stating: "Under this policy Aetna will allow payment at the full contracted rate for services that are provided in accordance with the Medicare definition of 'incident to' and are properly documented in the patient's chart." While AANP believes that payment should be based on services and not to the discipline of preparation, it also believes that the utilization of "incident to" billing is dated and counterproductive in today's health care environment. Such billing mechanisms prevent transparency and accountability by making NP provided care invisible to insurance carriers and preventing provider-specific outcome tracking. Additionally, "incident to" billing practice prevents efficient utilization of providers by artificially limiting the ability of NPs to meet patient care needs at the level of their license, education and skill by requiring direct physician involvement in care even when the care is within the scope of the NPs license. The AANP anticipates that Aetna will audit charts for compliance with "incident to" requirements (Remember, to meet the requirements for "incident to" billing, the physician must be on-site, all new patients must have an initial visit with the physician, and no new diagnosis or treatments be initiated by an NP without direct physician involvement in the patient care). As always, the AANP would encourage NPs to be familiar with billing requirements and ensure that claims are being submitted properly.

 AANP continues to collect information from our members on how the proposed June 1, 2010 Aetna changes will impact their patients and practice. While all the implications are not clear at this time, elements of the policy change may present opportunities for patients to select NPs as primary care providers. We are encouraging NPs to consider insurance credentialing and to review the Aetna materials online here to make informed decisions about their own practice situations. AANP anticipates a formal position on the Aetna policy to be available by the end of the summer.