I will be completing a general/minimally invasive fellowship in May and without being too specific, can anyone tell me what is an acceptable salary for someone with less than 2 years experience? The surgeon that I work with says that he wants to keep me, so I would like to have a salary in mind when we have the conversation. My job duties are inpatient rounding, putting in lines, and assisting in surgery. Thanks in advance.
May 12, 2010
Can Registered Nurse First Assistants Be Reimbursed?
Medicare and most other insurance companies reimburses for first assist to NPs. RNFA is not required. Many advanced practice nurses are being reimbursed by Medicare, but what about Registered Nurse First Assistants? Are they being reimbursed?
Response from Carolyn Buppert, NP, JD Attorney, Law Office of Carolyn Buppert, PC, Bethesda, Maryland
A Registered Nurse First Assistant (RNFA) is a registered nurse who has completed a minimum of 2000 hours of first assisting a physician with surgery and related preoperative, intraoperative, and postoperative care, and who is certified as such by a recognized organization. Medicare does not reimburse RNFAs at this time.
Florida Medicaid reimburses RNFAs, and in some states, private payers are required by law to reimburse RNFAs. These states include Florida, Georgia, Kentucky, Louisiana, Maine, Minnesota, Rhode Island, Texas, Washington, and West Virginia. In other states, RNFAs are not reimbursed.
However, Medicare reimburses assistant-at-surgery services if the assistant is a nurse practitioner, physician assistant, or clinical nurse specialist; if the surgery is one for which an assistant is reasonable and medically necessary; and if the hospital is not a teaching hospital.
The conditions for coverage of assistant-at-surgery services in teaching hospitals are more restrictive than those in other settings because of the availability of residents who are qualified to perform this type of service. Medicaid and the commercial payers also usually reimburse assistant-at-surgery services when medically necessary and reasonable and when performed by a physician, advanced practice nurse, or physician assistant.
Some advanced practice nurses who want to assist at surgery complete an RNFA program and become certified as an RNFA. These clinicians generally are being reimbursed because they are advanced practice nurses.
Medicare calculates payment for assistant-at-surgery services according to the following formula: when the assistant is a physician, payment is the facility-specific Medicare Physician Fee Schedule amount multiplied by the assistant-at-surgery reduction percent (16%), minus deductible and coinsurance, multiplied by 115%. In the case of a physician assistant, nurse practitioner, or clinical nurse specialist, the amount paid for serving as an assistant-at-surgery is the lesser of the actual charge or 85% of the amount that would otherwise be recognized if a physician had served as the assistant-at-surgery.  Medicare's rules for billing for an assistant-at-surgery are found in the Medicare Claims Processing Manual, Chapter 12, section 20.4.3. 
Last edit by NRSKarenRN on Jan 12, '13
: Reason: Article source and spacing