Who would be an Other Qualified Health Care Provider

[torresreb]

I've googled until my fingers have cramped and I cannot seem to find anything Medicare provided that would define who would fall under an Other Qualified Health Care Provider.

I'm working on ESRD reports and when I review the record for the Monthly Care Plan I find that there are many individuals who are working on managing the patient along with the physician.

does anyone know of a link that would provide a definition?

thank you!

 

[lisafer360]

“A 'physician or other qualified health care professional' is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports a professional service

https://www.findacode.com/articles/other-qualified-healthcare-providers-resource-475-to-finish-28231.html

 

[cgaston]

Non-physician providers fall under "Other qualified health care professsional" (some examples are Nurse Pracitioners (NP) , Physician Assistants (PA), Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM)).

They cannot give a list because it varies by state. You will need to check with your state to find out what types of providers can perform what services and whether or not they can perform them alone or if they need physician supervision.

Try googling "Other qualified health care professional in *your state*" and see what comes up

 

[medicalauditor]

I've googled until my fingers have cramped and I cannot seem to find anything Medicare provided that would define who would fall under an Other Qualified Health Care Provider.

I'm working on ESRD reports and when I review the record for the Monthly Care Plan I find that there are many individuals who are working on managing the patient along with the physician.

does anyone know of a link that would provide a definition?

thank you!

This is AAPC's definition - https://www.aapc.com/blog/25419-who-is-an-other-qualified-health-care-professional/