Wiki Nurse Practioner billing in Nursing homes

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MaggieFunk

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My provider has a NP that works with her to see nursing home & rest home patients. She wants the NP to see patients for their initial visit when she can not. I don't think she can but wanted to see if anyone else had experience or knowledge on this. Specifically she is looking at codes 99327, 99328 and 99305.
 
MaggieFunk said:
My provider has a NP that works with her to see nursing home & rest home patients. She wants the NP to see patients for their initial visit when she can not. I don't think she can but wanted to see if anyone else had experience or knowledge on this. Specifically she is looking at codes 99327, 99328 and 99305.
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I believe the NP can see the patient for the initial visit, however the service needs to be billed under the NP's NPI number and would be paid at 85% of the allowed amount. I would suggest you check with your state's regulations though, because each state is different on what they allow for the scope of an NP's practice. I found the following in CMS MLN Matters # SE1010 Revised:

Q. When may NPPs furnish an initial NF E/M service?
A. In the NF setting, an NPP, who is enrolled in the Medicare program and is not employed by the facility, may perform the initial visit when the state law permits this (See this exception in Publication 100–04, Chapter 12, Section 30.6.13.A of the Medicare Claims Processing Manual). A NPP who is enrolled in the Medicare program is permitted to report the initial hospital care visit or new patient office visit, as appropriate, under current Medicare policy. As discussed in the CY 2010 MPFS proposed rule (74 FR 33543), the long-term care regulations at Section 483.40 require that residents of SNFs receive initial and periodic personal visits. These regulations insure that at least a minimal degree of personal contact between a physician or a qualified NPP and a resident is maintained, both at the point of admission to the facility and periodically during the course of the resident's stay.

Hope this helps!
 
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Found this BILL.

Contents of the Bill
This legislation calls for direct reimbursement to nurse practitioners for providing Medicare Part B services that would normally be provided by physicians. The bill states that these services are not restricted by site or geographic location. Under the previous statute, nurse practitioner reimbursement was restricted to rural areas, long term care facilities and a service labeled "incident to" which is limited to follow-up care (i.e. no new patients and no old patients with new problems) in an office setting with a physician on site. It is the intent of this legislation that the "incident to" bill mechanism will no longer need to be used by nurse practitioners who now will be classified as Part B providers. Under this legislation nurse practitioners may see all new patients and old patients without restriction. There are no limitations on CPT codes as long as visits meet the established Medicare E and M requirements. The legislation also calls for nurse practitioners to be reimbursed for assisting at surgery.
 
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