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RNFA Reimbursement Required in June

Publish Date: June 5, 2016

Effective June 8, 2016, first assistant services performed by an RNFA in New York will be reimbursed by private payers, regardless of whether the RNFA is hospital-employed, physician-employed or self-employed. The new law prohibits payers from denying payment to RNFAs if the policy otherwise provides reimbursement to non-physician providers for first assistant services, but does not set reimbursement rates. We expect payers to reimburse RNFAs at the same rate that their existing policies are paying other licensed non-physician providers for first assistant at surgery services. In order to be eligible, RNFAs must hold the CNOR certification in operating room nursing.

AORN and New York AORN members worked diligently for several years to pass this legislation requiring reimbursement for RNFAs. Last year, the New York Senate and Assembly passed S1233A, which was signed by New York Governor Cuomo on December 11, 2015.

Steps you should take if you are an RNFA in New York:

  1. Seek credentialing with insurers in your area if you have not already.
  2. Obtain a National Provider Identification (NPI) number.
  3. Ensure your facility’s billing department is aware it should begin billing for first assistant services provided by RNFAs as of June 8.
  4. If you are self-employed, begin submitting claims to insurance companies for RNFA first assistant services provided after June 8.
  5. If you are physician-employed, your physician’s office can begin submitting claims to insurance companies for RNFA first assistant services provided after June 8.
  6. Remind your RNFA colleagues that reimbursement requirements start soon.

This new law applies to private payers and Medicaid in New York State. It does not change Medicare billing policies.

For questions from your facility or insurance companies, you can refer them to Senate bill 1233A, as amended by Assembly bill 9198. We expect New York to update its Insurance Code on June 8 when the new provisions become effective.

If you are interested in pursuing legislation in your state requiring RNFA reimbursement, please contact Danielle Glover, Government Affairs Manager.