Current Status of Services Reimbursed When Provided by Nurses in Advanced Practice
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Insurance Program
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Nurse Practitioners
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Certified Nurse Midwives
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Certified Registered Nurse Anesthetists
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Clinical Specialists
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Medicare – Part A
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Yes – Bundled Services
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Yes – Bundled Services
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Yes – Bundled Services
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Yes – Bundled Services
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Medicare – Part B
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Yes
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Yes
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Yes
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Yes
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Medicaid
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Yes – by law TCA 71-5-107(a)(24) for CNPs and FNPs
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Yes – by law TCA 71 – 5-107(a)(23)
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Yes – by law TCA 71 – 5-107(a)(22)
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Yes – Bundled Services
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Civilian Health & Medical Programs of Uniformed Services (Tri-Care)
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Yes
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Yes
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Yes
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Yes
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Federal Employees Health Benefit Plan (FEHB)
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Yes
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Yes
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Yes
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Yes – Psychiatric / Mental Health Specialists Only
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Private Insurers
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Yes – by law 1996 TCA 56-7
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Yes – by law 1996 TCA 56-7
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Yes – by law 1996 TCA 56-7
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Yes – by law 1996 TCA 56-7
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MCOs in TennCare
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Yes
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Yes
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Yes
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Yes
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Other MCOs
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Yes – by negotiation but not all MCOs
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Yes – by negotiation but not all MCOs
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Yes – by negotiation but not all MCOs
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Yes – by negotiation but not all MCOs
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1TennCare contracts include in the definition of primary care provider (gatekeepers) “registered professional nurses practicing according to state law.”
272% of nurses in advanced practice work in health professional shortage areas in Tennessee.
385% of anesthesia in rural areas is given by Certified Registered Nurse Anesthetists.
4 Medicare reimburses in all geographical settings effective January 1, 1998.
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