Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 219 Date: AUGUST 17, 2007

Transcription

1 anual ystem Pub edicare Program ntegrity epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 219 ate: UGUT 17, 2007 hange equest 5639 ubject: Nurse Practitioner (NP) ervices and linical Nurse pecialist (N) ervices. UY O NG: Under the instruction on NP services, is adding the National Board on ertification of ospice and Palliative Nurses (NBPN) to the list of recognized national certifying bodies for NPs at the advanced practice level. lso, under the N instruction, is adding this entire list of recognized national certifying bodies for Ns at the advanced practice level that is currently listed under the NP instruction only. Under the list of national certifying bodies that will be under the NP and N instructions, is replacing the National ertification Board of Pediatric Nurse Practitioners and Nurses with its current name, "Pediatric Nursing ertification Board". lso, is removing the ritical are ertification orporation and replacing it with its correct name, "N ertification orporation". New / evised aterial ffective ate: November 19, 2007 mplementation ate: November 19, 2007 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTUTON: (N/ if manual is not updated) =V, N=NW, =LT /N/ PT/TON/UBTON/TTL 10/12.4.5/linical Nurse pecialists (N) 10/12.4.8/Nurse Practitioners. UNNG: No additional funding will be provided by ; contractor activities are to be carried out within their Y 2008 operating budgets. V. TTNT: Business equirements anual nstruction *Unless otherwise specified, the effective date is the date of service.

2 ttachment - Business equirements Pub Transmittal: 219 ate: ugust 17, 2007 hange equest: 5639 UBJT: Nurse Practitioner (NP) ervices and linical Nurse pecialist (N) ervices ffective ate: November 19, 2007 mplementation ate: November 19, GNL NOTON. Background: edicare program qualifications for nurse practitioners (NPs) and clinical nurse specialists (Ns) under ederal regulations at and at respectively require these advanced practice nurses to be certified by a recognized national certifying body that has established standards for NPs and Ns. B. Policy: This policy is in accordance with (b)(ii) and (b)(3).. BUN QUNT TBL Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) arriers shall include the National Board on ertification of ospice and Palliative Nurses (NBPN) on the list of recognized national certifying bodies for NPs effective November 19, arriers shall enroll nurses under the NP benefit who are certified as advanced practice nurses by the NBPN and also meet all of the other NP qualifications effective November 19, arriers shall enroll nurses under the clinical nurse specialist (N) benefit who are certified as advanced practice nurses by any of the recognized national certifying bodies effective November 19, / B hared-ystem aintainers V W OT

3 . POV UTON TBL Number equirement esponsibility (place an X in each applicable column) provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within 1 week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. / B hared-ystem aintainers V W OT V. UPPOTNG NOTON. or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. X-ef equirement Number ecommendations or other supporting information: B. or all other recommendations and supporting information, use this space: V. ONTT Pre-mplementation ontact(s): egina Walker-Wren at (410) or at egina.walkerwren@cms.hhs.gov. Post-mplementation ontact(s): egional Offices V. UNNG. or iscal ntermediaries, arriers, and the urable edical quipment egional arrier (: No additional funding will be provided by ; contractor activities are to be carried out within their Y 2008 operating budgets.

4 B. or edicare dministrative ontractors (): The contractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work (OW). The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the contracting officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the contracting officer, in writing or by , and request formal directions regarding continued performance requirements.

5 linical Nurse pecialists (N) (ev.219, ssued: , ffective: , mplementation: ) Per Pub , chapter 15, section 210, a clinical nurse specialist must: Be a registered nurse who is currently licensed to practice in the tate where he or she practices and be authorized to furnish the services of a clinical nurse specialist in accordance with tate law; ave a master s degree in a defined clinical area of nursing from an accredited educational institution; and Be certified as a clinical nurse specialist by a recognized national certifying body that has established standards for Ns. The following organizations are recognized national certifying bodies for Ns at the advanced practice level: merican cademy of Nurse Practitioners; merican Nurses redentialing enter; National ertification orporation for Obstetric, Gynecologic and Neonatal Nursing pecialties; Pediatric Nursing ertification Board (previously named the National ertification Board of Pediatric Nurse Practitioners and Nurses); Oncology Nurses ertification orporation; N ertification orporation; and National Board on ertification of ospice and Palliative Nurses. Under (c)(3), clinical nurse specialist services are covered only if, among other things, the N performed them while working in collaboration with a physician. ollaboration is a process in which a N works with one or more physicians to deliver health care services within the scope of the N s professional expertise, with medical direction and appropriate supervision as required by the law of the tate in which the services are furnished. or more information on clinical nurse specialists, refer to: Pub , chapter 15, section 210 (Benefit Policy anual)

6 Pub , chapter 12, sections 120 and (laims Processing anual) Nurse Practitioners (ev.219, ssued: , ffective: , mplementation: ) Under (b), in order to bill edicare a nurse practitioner must meet the following conditions: services are furnished to practice as a nurse practitioner in accordance with tate law; and be certified as a nurse practitioner by a recognized national certifying body that has established standards for nurse practitioners; or services are furnished to practice as a nurse practitioner by ecember 31, Nurse practitioners applying for a edicare billing number for the first time on or after January 1, 2001, must meet the following requirements: services are furnished to practice as a nurse practitioner in accordance with tate law; and Be certified as a nurse practitioner by a recognized national certifying body that has established standards for nurse practitioners. Nurse practitioners applying for a edicare billing number for the first time on or after January 1, 2003, must meet the following requirements: services are furnished to practice as a nurse practitioner in accordance with tate law; and Be certified as a nurse practitioner by a recognized national certifying body that has established standards for nurse practitioners; and Possess a master s degree in nursing. Thus, any nurse practitioner applying for a edicare billing number for the first time on or after January 1, 2003, must meet the post-january 1, 2003 requirements. s stated in Pub , chapter 15, section 200, the following organizations are recognized national certifying bodies for NPs at the advanced practice level: merican cademy of Nurse Practitioners; merican Nurses redentialing enter;

7 National ertification orporation for Obstetric, Gynecologic and Neonatal Nursing pecialties; Pediatric Nursing ertification Board (previously named the National ertification Board of Pediatric Nurse Practitioners and Nurses); Oncology Nurses ertification orporation; N ertification orporation; and National Board on ertification of ospice and Palliative Nurses. n addition, under (c)(3) nurse practitioner services are covered only if, among other things, the nurse practitioner performed them while working in collaboration with a physician. ollaboration is a process in which a nurse practitioner works with one or more physicians to deliver health care services within the scope of the nurse practitioner s professional expertise, with medical direction and appropriate supervision as required by the law of the tate in which the services are furnished. or more information on nurse practitioners, refer to: Pub , chapter 15, section 200 (Benefit Policy anual) Pub , chapter 12, sections 120 and (laims Processing anual)