CMS publishes preliminary Rules of Importance to Nurse Practitioners

November 2, 2012, CMS

CMS issued preliminary final Medicare rules that we have been following and responding to through communication with CMS and public comment. They include issues related to ordering portable X-Rays, primary care Medicaid payments, transitional care, care coordination, DME, Telemedicine preventive services, telemedicine, PQRS and other relevant CMS authorized activities and payments. As we evaluate the new rules we will keep you posted regarding our analysis.

An initial review clarifies that nurse practitioners and other eligible providers are authorized to order Medicare portable x-ray services. That rule will be published November 16 and is effective January 1, 2013. It is not clear how, or if, the rule will be implemented retroactively. We will inform you as we seek additional clarification of the rule.

In a separate preliminary release, CMS has decided not to require nurse practitioners providing Medicaid primary care services to bill under a supervising physician in order to receive Medicare equivalent payments for primary care services they provide in conjunction with the PPACA 2013 and 2014 provision. They will however, be required to be under a physician's supervision in order to receive the Medicare equivalent payment. In states where NPs are paid a percentage of the physician authorized payment, that percentage will apply to the nurse practitioner in the Medicare equivalent program as well. This rule will be published on November 6.

Both rules are posted on the Federal Register public inspection website.

In the final fee schedule, two transitional care management codes have been developed that split transitional care into moderately complex and highly complex care to be used by providers such as nurse practitioners in the provision of transitional care. This is reflective of the RUC work we did with AMA in developing codes for transitional care and care coordination.

Watch our site for continued reporting and analysis of regulations currently being published by CMS. If you have questions contact us at 
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