Obstacles included collaborating dentists, direct reimbursement
, employees and facility, financial concerns, patient follow-up care, and mobile equipment.
Having achieved the ability to obtain direct reimbursement
under an individual Medicare provider number, future APRN reimbursement issues now generally parallel those of physicians.
is a self-funded plan that works much like an expense account.
From the employee's perspective, this system works more like an insurance plan than direct reimbursement
. The employee undergoing a rather expensive procedure, for example, would mostly likely pay only the co-payment up front, and the insurance company would process the claim and cover the remaining part of the bill.
The Rural Nursing Inclusion Act of 1990 provided that NPs and CNSs in rural communities could receive direct reimbursement
under Medicare along with the Federal Employment Health Benefits Plan (FEHBP) including third party reimbursement.
ADVANCED PRACTICE nurses (APNs) including nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists report that one of the barriers to their services is the difficulty in receiving direct reimbursement
(Anderson, Gilliss, & Yoder, 1996; Iris, 1999).
This period represents a dynamic time for the Medicare program, beginning with the increase in the annual cap on outpatient mental health services from $500 to $900 in 1988 and to $2,200 in 1989, and culminating with the elimination of the limit and extension of direct reimbursement
to clinical psychologists and social workers in 1990.
The American Dental Hygienists' Association (ADHA) offers resources for dental hygienists seeking to achieve direct reimbursement
. This information is available on the members-only site at www.ADHA.org in the Advocacy section under the Member Resources tab and includes Reimbursement at a Glance and Dental Hygiene: Reimbursement Pathways.
Advanced practice nurses should champion this initial step since it supports their ultimate goal of direct reimbursement
as primary care providers.
Most recently, Rhode Island became the 17th state in the country to afford direct reimbursement
to dental hygienists.
In 1997, direct reimbursement
to NPs regardless of geographic area of practice, was authorized by Congress.