The Impact of Changing Scope of Practice Laws on Nurse Practitioner Billing Patterns

Over the last decades, scope-of-practice laws for nurse practitioners (NPs) have changed rapidly, allowing for increased practice and prescribing autonomy. Despite this trend toward enhanced autonomy, scope-of-practice laws vary widely by state. At the federal level, Medicare implemented legislation in 1998 that began reimbursing NPs at a rate of 85% of a physician’s fee regardless of site of practice or geographic location, a change from previous versions that restricted NP reimbursement to rural areas and sites specific to long-term or follow-up care2. Since then, the number of NPs who have been billing on their own, has been increasing over time. The current study examined whether a change in scope-of-practice law toward more autonomous practice changed the rate at which NPs billed independently for their services. This project used a 5% sample of Medicare claims data from 1999 to 2014 to track the number of NPs who were billing Medicare for their services. Unique National Provider Identifier numbers were totaled and plotted over time by state to evaluate the change in trends. State changes to NP laws were catalogued through use of West Law, a legal research service that archives state legislative and regulatory changes. After identifying all relevant changes to scope-of-practice laws for NPs by state, NP billing trends were evaluated at times before and after these had gone into effect. Changes in scope-of-practice laws for NPs did not change the trends in the number or rate of these providers billing for their services. In a given state, a change toward more autonomy in practice did not affect the rate of the increase. The same trend was also seen in states that had the most dramatic changes in their laws. In 2005 in Wyoming and 2010 in Maryland, each state passed legislation removing the requirement for NPs to have a collaborative agreement with a physician, effectively allowing for independent practice. Yet, the figures show the trends in NPs billing independently was consistent with rates seen before these legislative changes. Understanding the effect of changing scope-of-practice laws on NP practice patterns will be essential to informing current and future regulation of these providers. While this trend has been increasing steadily over time, the rate at which NPs billed Medicare independently did not dramatically change with increased practice and prescribing autonomy in state legislation, which may be a key piece to alleviating some of the strain on the primary care workforce. 1. Kaiser Family Foundation. Medicaid Benefits: Nurse Practitioner Services, 2003 – 2012. Date accessed September 15, 2017. https://www.kff.org/medicaid/state-indicator/nurse-practitioner-services 2. American Association of Nurse Practitioners Fact Sheet: Medicare Reimbursement, 2013. Date accessed September 15, 2017. https://www.aanp.org/practice/business-practice-management/reimbursement/68-articles/325-medicare-reimbursemen