| 1966 |
Federal government instituted Medicare
and Medicaid reimbursement plans. |
| 1981 |
OBRA decreased federal spending
for health care. |
| 1982 |
TEFRA placed a ceiling on hospital
rate increases. |
| 1982 |
Certified nurse midwives reimbursement
set at 65% of physician fee with NO requirement for physician supervision. |
| 1983 |
DRGs established as a Medicare
prospective payment system for hospitals. |
| 1983 |
Institute of Medicine (IOM) reported
that NPs provide primary health care services of equal quality at less
than one-half the cost of primary care physicians. |
| 1989 |
OBRA enacted a new payment system which introduced
fee schedules based on the resources and effort needed to perform a
service. It allowed pediatric and family nurse practitioners (PNPs
& FNPs) to be reimbursed according to complex regulations. It was phased
in over a 5-year period beginning in 1992.
|
| 1990 |
OBRA clarified Medicare reimbursement
to FNPs and PNPs in primary care and NPs and CNSs in long-term care nursing
facilities. |
| 1996 |
Strict regulations now required on-site supervision
of residents in teaching hospitals and co-signing of charts by supervising
physicians. Hospitals have been fined and criminal charges are possible
for overcoding. Typically, audits also uncover a great deal of undercoding
in health care reimbursment.
It needs to be clear that APNs are not in
the same category as physician residents and physician assistants and
do not require MD supervision or co-signatures unless the APNs are billing
in the "incident to" category.
|
| 1997 |
Balanced Budget Act (BBA1997) removes
distinction for NP and CNS reimbursement by geographic area. Contains
requirement for physician collaboration. Allows NP/CNS reimbursement as
long as a facility fee is not charged. Problems remain for APN billing
in hospital settings. However, there is difficulty in writing the regulations
to enact this legislation. |
| 1997 |
Federal concerns with Medicare
fraudulent billing have resulted in Medicare audits around the US and
stringent requirements for documentation, coding and billing procedures,
particularily in teaching hospitals where physician residents provide
patient care. |
| 1999 |
1999 Balanced Budget Act (BBA 1999)
|
