Writer's choice Term Paper Example | Topics and Well Written Essays - 750 words - 1

Writer's choice - Term Paper Example This paper focuses on the methods and tools of hunting employed by each category of man’s evolution. Supposedly, Homo habilis, Homo erectus and Neanderthal each used different methods of hunting and despite similarities in tools, each level of evolution had unique skills of using the tools (William, 47). Homo habilis it is believed to have existed 2.3 million years ago, with a brain capacity of about 650 cc. History shows that the Homo habilis fed on meat and plants. For them to survive with changes in their environments, they had to invent new ways of getting food. The inevitable need for change caused Homo habilis to invent stone tools that were used for hunting (Strada, 24). The Homo habilis, commonly referred to as the maker of crude tools, curved out round stones to obtain sharp edges. Use of the stone technique marks the beginning of an interesting use of brain by man. Historically, Homo habilis are credited for inventing tools. Homo habilis made stone cobbles which they used for hunting, and wedged stones that were used for cutting. These tools helped Homo habilis in chores like hammering, chopping and digging holes. Apparently, these chores were used for the primary purpose of making traps for animals. Actually, the Homo habilis invented tools for the sole purpose of improving hunting techniques. Most tools used by the Homo habilis were found in East Africa and parts of Asia (William, 56). Remains of Homo erectus were discovered in Indonesia, and are alleged to have existed more than 1.8 million years ago. Unlike the Homo habilis, Homo erectus had a larger brain capacity. The bigger brain would later be used to develop the element of speech. Members of the Homo erectus are credited for inventing Acheulean tools (William, 46). Similar to any other category of man’s evolution, Homo erectus also hunted animals for food but used more improved methods. For instance, use of better traps and fire commenced during the Homo erectus

Globalization and International Relations Essay

Globalization and International Relations - Essay Example However, since globalization, the global economic environment has undergone tremendous changes. According to Devetak and Hughes (2008, p. 34), globalization connects nations through a global network, and it assists a nation to get access to foreign markets and customers. Since the nations got ranges of benefits from globalization, governments adopted a liberal approach towards international trade. As Slaughter & Swagel (1997) point out, the removal of trade barriers promote import and export activities by which a government acquires foreign investments (IMF). In order to take advantages of liberal international trade laws, a number of corporate global giants spread their business across the globe; this practice greatly promoted international relations. For instance, Starbucks Coffee Company transplanted its business operation from the United States to China. The improving unemployment rates in third world countries can also be clearly referred to the fruitful effect of the globalizat ion. The global interconnectedness helped these nations to attract more and more investors to complete their capital accumulation process successfully. In addition, multinational companies started their production activities in developing and underdeveloped countries and this practice created ranges of employment opportunities in those countries. Globalization has also intensified the immigration processes. Even though the ultimate cause of immigration is not globalization, this concept has considerably increased the number of immigrants (‘Migration and globalization’). Before the 21st century, traveling from one’s home country to a foreign destination was expensive and time consuming. In addition, inter-communication between countries was... This essay approves that the productive elements of globalization contributed to the development of a new technological era that restructured the living standards and business concepts of the modern world. The increased application of technology in productive activities also augmented the volume of production. It was necessary to employ more and more workers in order to efficiently operate machineries and other technical systems. This situation also created wide ranges of job opportunities for skilled individuals. Similarly, even technologically underdeveloped nations got access to improved technologies as a result of globalization and this situation in turn improved international cooperation. The explosive growth of information technology (IT) is one of the major outcomes of globalization and industrial revolution. Globalization has also intensified the immigration processes. Even though the ultimate cause of immigration is not globalization, this concept has considerably increased the number of immigrants. This report makes a conclusion that globalization has greatly added value to international relations as this concept facilitates international trade transactions. Increase in export and import trade encourages nations to function cooperatively. The globalization also amplified immigration by which nations could resolve their staffing shortage issues. Moreover, developments in IT sector have greatly restructured the ways nations communicate today.

Argumentative Research Essay Example | Topics and Well Written Essays - 1250 words

Argumentative Research - Essay Example This essay will try to decide the question whether multiculturalism is good or bad for America. America has been called a melting pot of cultures since the last many decades. The situation is so prevalent that when you see whole areas of cities being taken over by a particular community like Chinese, Indians, Armenians and Latinos, you wonder if you really are in America after all. It is so surprising to see that road signs, shop signs and advertisements for products, services and even jobs are put up in Chinese, Hindi, Spanish or whatever the language of use in these parts of America. Added to this, these groups are often very protective of their rights and duties and would fight if any others want to take over their turf. They also want their own members who speak their own language to be part of the local administration at City Hall and in the police and rescue services. Of course there is Little China or Chinatown in a part of many cities but this part is locally devoted to Chinese cuisine and also sports a little of Chinese culture. As an international student in America I am glad for this although the dialect I speak may not be the same as theirs. Even a person who looks like a Chinaman is good enough to please me. So I think it is the same for people of other cultures and nationalities- that they are pleased to see and hear people who are from the same country as them or have people back in the home country. They generally get together in one area and seek to help others buy property in the same area till they form a majority and then the language is also changed to their home language and the culture becomes a set part of the landscape. According to something called diversity which is practiced in America there is a rule that if the majority of the local population is belonging to a particular culture, then there should also be adequate representation of these people in the local administration and

Globalization and International Relations Essay

Globalization and International Relations - Essay Example However, since globalization, the global economic environment has undergone tremendous changes. According to Devetak and Hughes (2008, p. 34), globalization connects nations through a global network, and it assists a nation to get access to foreign markets and customers. Since the nations got ranges of benefits from globalization, governments adopted a liberal approach towards international trade. As Slaughter & Swagel (1997) point out, the removal of trade barriers promote import and export activities by which a government acquires foreign investments (IMF). In order to take advantages of liberal international trade laws, a number of corporate global giants spread their business across the globe; this practice greatly promoted international relations. For instance, Starbucks Coffee Company transplanted its business operation from the United States to China. The improving unemployment rates in third world countries can also be clearly referred to the fruitful effect of the globalizat ion. The global interconnectedness helped these nations to attract more and more investors to complete their capital accumulation process successfully. In addition, multinational companies started their production activities in developing and underdeveloped countries and this practice created ranges of employment opportunities in those countries. Globalization has also intensified the immigration processes. Even though the ultimate cause of immigration is not globalization, this concept has considerably increased the number of immigrants (‘Migration and globalization’). Before the 21st century, traveling from one’s home country to a foreign destination was expensive and time consuming. In addition, inter-communication between countries was... This essay approves that the productive elements of globalization contributed to the development of a new technological era that restructured the living standards and business concepts of the modern world. The increased application of technology in productive activities also augmented the volume of production. It was necessary to employ more and more workers in order to efficiently operate machineries and other technical systems. This situation also created wide ranges of job opportunities for skilled individuals. Similarly, even technologically underdeveloped nations got access to improved technologies as a result of globalization and this situation in turn improved international cooperation. The explosive growth of information technology (IT) is one of the major outcomes of globalization and industrial revolution. Globalization has also intensified the immigration processes. Even though the ultimate cause of immigration is not globalization, this concept has considerably increased the number of immigrants. This report makes a conclusion that globalization has greatly added value to international relations as this concept facilitates international trade transactions. Increase in export and import trade encourages nations to function cooperatively. The globalization also amplified immigration by which nations could resolve their staffing shortage issues. Moreover, developments in IT sector have greatly restructured the ways nations communicate today.

Do revolutions 'happen' or are they 'made' Discuss with reference to Essay

Do revolutions 'happen' or are they 'made' Discuss with reference to at least two theories of revolution, and using exa - Essay Example A revolution is known to be a change, a metamorphosis for the outbreak of the whole political, social and economic system of a certain area. The whole setup is not just crashed because of some unknown reason of just by a group of people who are seeking their vested interest; rather, there is some lack and seepage in the system which in turn gives rise to the revolution. The primary advocates of this theory include Aristotle. He says that causes of every revolution lie in mass spread inequalities, rejection of the working class by elite class of the society and oppressive behavior of the rich. The rejectionist behavior that is faced by majority of the masses makes them set their foot out for a change that will bring them eventually some honor, pride, power and money. Abuse of standards of legal frameworks and misuse of power by the privileged class are also the main causes of revolution. ... will try to oscillate the running system because the majority is happy with the system and any attempt from outside to throw away the current regime will not be entertained by the environment or the people. According to this theory, the revolutions are triggered by the events caused by the running class, and then these events can be manipulated by other parties who have their own interests in the coming revolution, but this does not mean that revolutions are made up by some powers initially. The idea is that each revolution is started internally on some causes that are very much anticipated in the books of revolution. Aristotle said that under corrupt regimes, people are tired to rule over by fear and brutal behaviors. As a result of this, the ambitious people get their emotions beefed up and they set out some movements to change the tyrant and oppressive ruling class. This is the stage when other powers can show interest, but the starting of the revolutions has already taken place. Karl Marx was in support of the same theory as he said potential working class and lower middle class are often offended by the upper class or the rich class because they regard themselves as some kind of more privileged people than others. They think the production in society is earned by them, and this gives them every right to harm or humiliate the lower classes. They can also hurt their feelings because they are gentiles in their view. As a result, the consequences take the form of revolution and the working class uses their numerical edge and power of numbers against the ruling class because the suffered class has always been in majority and exploitative classes are always in minority. When there is an open battle between minority and majority, the end result goes in favor of majority

American Involvment in World War I Essay Example for Free

American Involvment in World War I Essay This investigation assesses American involvement in World War I before military intervention, and how this led to military intervention. In order to assess these causes, one must examine America’s involvement in the war before combat, the events that launched America’s military intervention in the war, American sentiments about the war before military intervention, and Woodrow Wilson’s actions before the war. Two sources used in the essay, America’s Great War: World War One and the American Experience by Robert H.   Ziegler and Woodrow Wilson’s speech to congress on April 2nd, 1917 are evaluated for their origins, values, purposes and limitations. The investigation does not asses the pre-war situations of any countries but the United States, and does not asses American military involvement during the First World War Summary Of Evidence Prior to 1917, America was already deeply involved in the First World War, though they did not have troops fighting in the trenches overseas. First, American involvement in the war was purely as a producer and creditor to the Allied Powers. The war, while catastrophic for the countries involved in its atrophied trench battles, provided America with an astronomical boost to its economy, from 2 billion dollars in exported materials in 1913 to nearly 6 billion dollars in exports in 1916. This economic boom was mainly brought on by Britain’s dependency on American foodstuffs and manufactured goods.. The economic ties between America and Britain tightened with public subscription loans. By 1917, Britain had borrowed 2. 7 billion dollars from American creditors. Historian Paul Koistinen wrote â€Å"Without American supplies, Britain could not continue the war; without American financing of almost 10$ million a day †¦ Britain would exhaust its reserves of gold and securities by March 1917. Its dependence was total. Cutting back procurement . . . would produce disaster in England† Originally, America did nothing but reap the reward of â€Å"neutrality†. When Americas turned their eyes to the stage of war in Europe, they were truly terrified. One Chicago newspaper joked â€Å"A hearty vote of thanks to Columbus for having discovered America†. This sentiment was echoed by many American citizens, who showed pride in President Woodrow Wilson’s decision to declare America a neutral state in the war. Americans thoughts on the war lied in their bloodlines, as a majority of Americans were descendants from either Allied or Central Powers nations. Most Americans, early in the war at least, didn’t understand the war or why it was being fought, and were glad that America wasn’t involved. However, these robust Anti-Involvement sentiments began to fade after May 7 1915, the day of the Lusitania crisis. German U-Boats torpedoed and sunk a passenger liner in British waters, killing nearly 1,200 civilians, including 128 American citizens. The murder of these innocents set off the first widespread pro war feelings in Americans. This outrage was justified, but was also heightened by yellow journalism that demonized Germans as barbarians and deranged killers. President Woodrow Wilson, taking note of this event and the outrage it caused, warned the Germans that any further violation of American rights would result in â€Å"Strict Accountability† for these actions. This, as well as the bloody war dragging on in Europe, brought up the question of military preparedness in the United States. By 1916, pro-preparedness sentiment was widespread, as 135,000 supporters of expanding the military marched on New York City’s 5th Avenue, for 12 hours. In Chicago, 130,000 telephone operators moved in the shape of an American flag, goose-stepping down State Street. In the election of 1916, Woodrow Wilson ran against Charles E. Hughes, who was backed by Theodore Roosevelt, former president and staunch Allied Powers supporter, as well as an advocate for military preparedness. Woodrow Wilson won the election by only about 600,000 popular votes. However, these sentiments were met with an equally strong anti-militarism force, saying that in a chaotic world, America must be a beacon and resist entrance into war, and resist building an enormous military. Strong anti-militaristic sentiments began to fade when British intelligence officers intercepted a telegram sent from Foreign Secretary of the German Empire Arthur Zimmermann to the German ambassador of Mexico, Heinrich von Eckardt. This infamous proposal, known as the Zimmermann note, proposed that Mexico wage war against the United States. Throughout America’s neutrality in World War 1, President Wilson had acted as a mediator, but with tension building to a terminal level and with the Zimmermann note, Wilson was forced to ask congress to bolster America’s military forces on April 2nd 1917. Later in the same year, America sent its first military forces oversees Evaluation Of Sources Robert H Zieger: America’s Great War: World War One and the American Experience Origins- (2000) Zieger is a respected labor historian Purpose- Provides an in-depth look at American involvement in the war. Value- The economic statistics and quotations from various primary and secondary sources allow the reader to evaluate the validity of the claims Zieger makes. Limitations- does not provide any new opinions or claims Woodrow Wilson, April 2nd 1917 to congress to persuade congress to bring the United States Origin- German hostile actions towards the United States Purpose- Persuade congress to declare war on Germany and the Central Powers Value- clearly outlined Wilson’s reason’s for entering war Limitations- doesn’t explain the underlying causes of military intervention or pressure from big business to declare war for entry  Analysis America’s involvement in World War One began with producing vital weapons and foodstuffs for the Allied Powers, as well as economically supporting the Allied nation’s governments. Throughout the war, the German Empire repeatedly acted belligerently towards the neutral United States, sinking passenger lines, killing Amer ican civilians. Tension with Germany also rose after the proposal to Mexico asking the Mexican army to wage war on the United States. These belligerent German acts, however, would not have held as much effect as they did if American political opinions had not been shifted by the German actions, the economic pressure of close ties to the Allied nations, or social pressure brought along by shifting political attitudes. These all contributed to tensions growing regarding American military involvement I World War One President Woodrow Wilson was a stalwart proponent of American neutrality in the First World War for the almost all of the war, but the American political climate at the time forced his hand.. He was able to win this election because most voters at the time had pro-neutrality sentiments. However, Wilson took into account his slim margin of victory, and the Republican’s yearning for a prepared military. These yearnings were brought on mainly by the Lusitania sinking. A major proponent for intervention, the previously mentioned Theodore Roosevelt, denounced these acts of the German Empire as acts of piracy. Roosevelt’s popularity made these statements extremely well heard. This shift in public opinion helped force President Wilson’s hand. America’s involvement in World War One before it entry in combat was extremely vital, producing millions of dollars’ worth of material for Britain and France, as well as financing the war through small loans. This dependency was built by J. P Morgan, who traded nearly 3 billion dollars’ worth of goods with the allied powers. By 1917, America had invested 2. 7 billion dollars in Britain alone. Historian Paul Koistinen’s quote regarding British dependency on American trade shows how deeply entrenched America was with the war’s affairs pre involvement. These statistics show that the allied powers were completely dependent on American economic support American corporations had an immense amount of wealth in the war, and if they Allied powers lost the war, all of their investments would be worth nothing, because the countries that had been responsible for repaying these debts would no longer exist. The war was taking a detrimental toll on the populations of the warring nations, and the war was almost completely atrophied. It was only a matter of time before one side lost, and it was essential to American business that it was the Allied Powers. Had the allied powers lost to the central powers, American financers would have lost 2. 7 billion dollars as a whole, 2. 7 billion dollars that were needed to give to American business, 2. 7 billion dollars that banks needed to stay in business. Throughout pre-involvement America, as early as the dawn of the war, so called â€Å"hyphenated Americans†, had opinions on what side of the war to support, dependent on their country of origin. German-Americans, the largest ethnic group at the time , supported what they thought of as their motherland, Germany, therefore supported the Central Powers. The second largest ethnic group, Irish-Americans, saw Great Britain as an oppressor, therefore were also supporters of the central powers. However, most Americans at the time were still pro-neutrality. A Chicago newspaper, expressing thanks to Columbus, wrote an article on the blessing of the Atlantic Ocean. This was a popular sentiment at the time, and many Americans were proud of Wilson’s decision to be neutral. After the sinking of American ocean liner Lusitania the support of neutrality began to fade. Before the Lusitania disaster, however, 92 ships had been sunken by aggressive German action. None of these attacks had gained as much publicity, partially due to the fact that the previous sinking’s hadn’t been as destructive. But this was also due to the fact that the Lusitania sinking was grabbed onto by yellow journalists. â€Å"The blood of these murdered victims cries for vengeance. If that cry is unheard, the people of the United States will always bear upon them the stigma of the greatest humiliation ever put upon a nation. Writes a reporter from the Toronto Telegram. President Wilson demanded that German U-Boats stop sinking civilian liners, and if they continued to do so, they would be met with military retaliation. This didn’t stop Germans from sinking boats, and Wilson’s failure to take action against them infuriated Americans. Observing the protests in American cities at the time, one can judge that huge masses of people were strongly in favo r of interventionism. Conclusion The process of the American military joining the Allied Powers seemed inevitable from the start of the war, but still took hostile action and over reaction to spark military involvement. America’s pre-war economic ties to Europe and America’s reliance on trade with these nations during the war made America’s involvement with these nations too deep to let them lose the war, therefore forcing combat. Woodrow Wilson’s strong stance on neutrality couldn’t stand up to the enormous pressure he faced from the people of the United States.

Reimbursement Issues For Nurse Practitioner Health And Social Care Essay

Reimbursement Issues For Nurse Practitioner Health And Social Care Essay The Balanced Budget Act of 1997 was unquestionably a frontward step for advanced practice nurses (APNs).   Payment is remarkably allowed for all settings as long as no other provider fee or other facility fee was being paid in relationship to the assistance supplied by the APN.   The various constraints on settings for services provided by the advanced practice nurse were totally removed from the guidelines (Bardach, 2006). The regulations for reimbursement of APN services typically changes based on the category of setting. Within the office setting, the permissible reimbursement to nurse practitioners is only 85% of that of a physician. This same reimbursement is acceptable only if billed straight under the nurses name and provider number (Fishman, 2002). The decrease in conversion factor for Medicare for reimbursement has affected rural clinics. This paper will discuss some pressing issues regarding reimbursement for nurse practitioners. I. Crucial Areas for Reimbursement that Nursing Practitioners Should Know 1. An advance practice nurse (APN) should be responsible and aware of the reimbursement process. APN must have read the participation contracts involved. They must determine the following: Does the plan credentials the APN and assigned a provider number. What are the claim submission requirements?   It could be direct billing or billing which is conducted by a supervising physician. And what are the time frames for submission. Can appeal mechanisms for claims denial be conducted? What are the covered services? Is it reimbursement methodology capitation or fee for service, etc? 2. An APN must familiarize documentation requirements in order to support the Certified Performance Technologist or CPT. Last 2001, the Office of Inspector General had conducted reviews on nurse practitioner, clinical nurse specialist and assistants of physicians. This is to comply with the Health Care Financing Administration or HCFA rules and regulations. (Cooper, 2000) II. Understanding the Reimbursement Procedure In order to better understand the underlying reimbursement issues in nursing practitioner, we must first have a clear grasp on the reimbursement process itself. In 1965, two methods, the Medicare and Medicaid of Social Security Act were amended by the Congress. These two will be discussed thoroughly in the next sections of the paper. With the first method, Medicaid, 100% of the physician rate is reimbursed. This will only apply if the incident to criteria are met. The phrase incident to refers to the services provided by nursing practitioners where a physician is actually present, or available for consultation. In order to verify the presence of the attending physician, the patients contact, appointment schedule or a documentation of the medical records can be used. The local Medicare will give the nursing practitioner a unique identification number (UPIN) for his or her bills. For a direct reimbursement, a practitioner must undergo an application process conducted by the payer. With the second method, Medicare, the nursing practitioner receives 80% of the fee that is set by the practice. Or they also have the chance to receive 85% of the Medicare physician fee schedule. One disadvantage of this method is that it reimburses the lowest charge possible. Citing an example, a practitioners bill for his or her services is $120 and Medicare only allows $100, the practitioner will only reimburse $85, which is 85% of the Medicare allowable. (Rapsilver, 2000) II. General Issues There are various notable issues connected to the reimbursement for services provided by the APNs. They are expected to take possession and responsibility of the procedure on the reimbursement. The APNs should first begin with comprehending their involvement contracts with health care plans to ascertain the following items (Fishman, 2002): if the said health care plan will give credit to the nurse practitioner involved and will consequently assign a provider number, if there are any appeals procedures for denials of claims, if it is possible to review the comparison of fee for service versus the plans reimbursement methodology capitation, etc., if claims such as billing under the administering physicians name or direct billing ask for requirements to be submitted within a specific timeframe; and, if all specific services are covered On the secondary topic, nurse practitioners should become familiar with various requirements when it comes to documentation to sustain appropriate CPT coding. APNs should refer themselves to the HCFA rules and the Federal register for guidelines (Bardach, 2006).   The nurse practitioner should actively participate on internal audit of documentation to find out if their documentations support the CPT code billed. APNs should responsibly scrutinize an illustration of their assortments against their monthly charges. This guarantees that reimbursements are properly made according to contract and that no charges are being denied. (Kansas Nurse, 2008). III. Medicaid Reimbursement Process Issue The lack of consistent progress in the Medicaid hospital reimbursement processes has left the nurse practitioners confused and disappointed over the past few years. Progress towards simplifying the Medicaid reimbursement process has been slowed by the absence of relevant policies in hospital reimbursement, memberships, and the level of access for the members (Fishman, 2002). The lack of priority and actions from the leaders of healthcare to implement the policies for the Medicaid hospital reimbursement processes resulted to the decline in the productivity of the program and posed major setbacks for nurses. With the necessary improvements not being achieved, the government is left with nothing to use in integrating the needed reforms in the Medicaid hospital reimbursement processes. Suspended reforms for Medicaid hospital reimbursement processes reveal incoordination among various health departments which significantly affected Medicaid members. The adverse effects of the current economic crisis put local governments in a state of uncertainty whether to pursue plans of implementing the new Medicaid hospital reimbursement processes to handle the health needs of their residents (Farley, 2000). Over the past few years, the local governments have been limited with their actions to completely adopt the new Medicaid hospital reimbursement processes. In New York alone, residents that are not yet affiliated with Medicaid have reached a number of almost 4 million. New York, however, is still way ahead in terms of progress as compared to other states in America. Still, according to Bardach (2006), the majority of New York residents are completely dependent to the Medicaid program because: (1) Medicaid assists them in the access of health benefits; (2) Medicaid assists them by means of health insurance. Yet these Medicaid policies also led to New Yorks health issues due to the lack of coordination by the leaders. IV. Medicare Reimbursement Process Issue Many advanced practice nurses inaccurately presuppose that receiving an APN license eliminates all obstructions to getting reimbursements for all their services by the insurance companies.   The primary goal obviously is to achieve direct reimbursement, which basically means being able to bill in the APNs exact name and not that of the or under the physician.   This is because being billed under a doctors name austerely propagates the invisibility of the nurse practitioners (Fishman, 2002).    To accomplish this goal of straightforward reimbursement, advanced practice nurses have to be empanelled by a reimburse-er or have to get a provider status.   The methodology for Medicare had primarily implicated achieving a PIN or a Provider Identification Number, which has now transformed into the new NPI or the National Provider Identifier (NPI).   Ã‚   In reality, as an example, Medicare already was issuing PINs to advanced practice nurses in Illinois two years before the APN regulations for practice were written.   Comparatively, Medicaid in Illinois was also agreeable to directly reimburse advanced practice nurses even before Medicare (Bardach, 2006). The frequent misconception of many advanced practice nurses about Medicare is that if a contributor gets a Medicare number, he or she will be reimbursed mechanically by every other insurance corporation, including PPOs and HMOs.   That is very wrong since insurance companies create or develop their own precise policies.   It can then be said that what one company permits, another one might not (Fishman, 2002).    V. Private Insurance In the United States, there are many private insurance plans that exists. Due to this, the guidelines for advance practice nurses are highly variable. There are times that the plans include the nurse provider in the preferred provider network. But there are also times that the nurse provider is considered outside the preferred provider network. So in general, less coverage is then afforded for the services rendered by nurses. These phenomenal places burden on those who have minimal resources. The number of networks that seeks to include practitioners among their credential providers is increasing. When discussing about the reimbursement issues, the fact that advance practice nurses always receives less payment that physicians arises. Advance practice nurses have been taught how to provide high quality care which is equal to the care provided by physicians. Because of this, they should be paid an equitable fee for the services they have rendered. Efforts are now exerted in order to fix these inequities. (Lundy) VI. Why APNs Do Not Receive Equal Reimbursement The Medicare Payment Advisory Commission or MedPAC examined the payments differencials between the clinicians and physicians. Why does this two groups do not get equal reimbursements? The MedPAC conjured that there is actually no analytical foundation that can support this. So in order to answer this question, the Commission investigated if these two groups, physicians and non-physician providers produces the same products or different products. According to the Commission, the Medicare must set the service payment equal to the cost incurred in efficiently rendering the service. Whenever the physicians and clinicians have provided the same service, then the payment for the low cost provider must be applied for all service providers. In many cases, there are many distinguishable differences between the services rendered by physicians and clinicians. Citing an example, according to reimbursement data, clinicians who are not physicians demonstrates a less complex evaluation and management services than physicians. Other specializations and surgical services are not included in the scope of practice of certain clinicians. Adjustments and changes for these types of billing codes include differences in resource costs. Since the nature of billing codes is imprecise, the Center for Medicare and Medicaid Services were not able to distinguish the different categories of clinician who provide similar services. They have this assumption that physicians are much prepared to diagnose and treat patients that have severe illnesses. But, contrary to this, anecdotal reports stated that other clinician sometimes spend more times in checking and treating patients with severe illnesses or who are in critical conditions, which made the physicians to care for a greater number of patients with lower acuity. Whenever a physician and other clinician bill for the same service, it is very difficult to tell of the physician saw a more complex patient. Due to these uncertainties in comparing their services, the Commission is reluctant in altering the payment differential. And certain policies even on the same company might be allowed in one state but not in another state.   As point of the matter, if one company has three product lines such as HMO, fee-for-service or indemnity, and PPO, then it may also have three dissimilar guiding principles for nurse practitioners (Bardach, 2006).    Consecutively, to ultimately become a credentialed contributor for each insurance plan that patients are secured with, a nurse practitioner must then submit an application for provider category with each and every insurance company, including Medicare and Medicaid. From that discussion, every provider must be familiar with some fundamentals about Medicare. First and foremost, there is Medicare Part A, which actually covers skilled nursing home, hospital, and home health charges; and then there is Medicare Part B, which then envelops most outpatient services, the care patients in particular obtain from doctors offices (Fishman, 2002). When it comes to the incident to billing, the Commission decided to consider that services rendered by clinicians who are not physicians but billed as incident to must be paid 100% of the physician fee schedule. The Commission have stated that the incident care fee is predicated upon the care or service provided by the team, with the non-physician giving the direct patient care services and the physician taking responsibility to the over-all welfare of the patient. They concluded that the team approach to care provides value which warrants payment at the full rate. (Edmunds, 2002) V. Conclusion Reimbursement issues have become challenge to nursing practitioners. Among the critical areas that NP should know are the following: the reimbursement process, contracts and the documents required. They are expected to take possession and responsibility of the procedure on the reimbursement. The APNs should first begin with comprehending their involvement contracts with health care plans. Secondly, nurse practitioners should become familiar with various requirements when it comes to documentation to sustain appropriate CPT coding. APNs should responsibly scrutinize an illustration of their assortments against their monthly charges. VI. Preparing for Future APN Reimbursement Being part of the healthcare system, Advance Practice Nurses (APNs) continue to search for greater quality, effectiveness and effeciency in delivering care. Many organizations and institutions like Center for Medicare and Medicaid Services (CMS) are taking the lead in identifying and validating indicators of high quality health care aiming to streamline delivery of care and to reduce convulated health care costs. à ¢Ã¢â€š ¬Ã‚ ¢ Composite Measures a reimbursement coding category that is currently being validated to deliver quality measures which can lead to desired patient results for chosen chronic diseases or conditions. (Kennerly, 2007) Establishing these new standards are based on the assumptions that by using them will cause a consistent high quality of outcome for the majority of patients and there will a great decrease in health care cost. The CMS is currently focusing on reforming quality reimbursement sytems which can save money while rewarding those care providers for their quality performance. à ¢Ã¢â€š ¬Ã‚ ¢ Pay-for-Performance led to determining the importance of implementing a common set of clinical standards for medical care. This means a providers performance and reimbursement is now and in the future will depend on and be judge against a national standard for care rather that past provider;s performances. (Kennerly, 2007)