Quote from juan de la cruz
I'm not sure how ACA and the insurance companies empanel NP's into the PCP list. All I can surmise is that NP's can have a specific taxonomy when they obtain an NPI number. The taxonomy corresponds to the type of NP they are (ANP, ACNP, FNP, etc.). However, some NP's did not specify this taxonomy when they applied for an NPI their number.
Juan, you area wealth of knowledge.
You are correct on the taxonomy issue.
However, I believe the commercial insurance part of 100% reimbursement is somewhat more complicated. I don't know if the ACA is partially or fully responsible for NP reimbursement rates through commercial insurers. What I do know is that with the taxonomy not distinguishing what NP specialization one performs, commercial insurers that reimburse at the 100% rate do so without regard to what your specialty is.
I know this because I have my own practice in a non-inde state. (My state requires collaborative practice for those who are wondering how I do this.)
It is a specialty practice. But because my NPI taxonomy is general and there is no longer E&M consultant codes, insurers cannot distinguish what service you are rendering. I don't know which payors reimburse at the 100% rate but I can tell you I haven't had many. Still, it's worth mentioning since we're on topic.