Important Rule Affecting Nurse Practitioners and Clinical Nurse Specialists Relating to Enrollment, Documentation, and Ordering and Referring Requirements

Abstract

Nurse practitioners (NPs) providing services to Medicare beneficiaries must take note of, and comply with, a May 5, 2010, Centers for Medicare and Medicaid Services (CMS) ‘‘interim final rule with comment.’’ The regulation is still final even if it permits an opportunity to comment. It simply means that CMS is open to comments and may revise it. The regulation implements several provisions of the new federal health reform law, the Patient Protection and Affordable Care Act (PPACA). It also is in furtherance of a new CMS emphasis on provider enrollment. Effective July 6, 2010, there are documentation requirements that apply not only to NPs making referrals for certain items and services but also to NPs furnishing those covered items and services. They relate to items and services identified as being at high risk for waste and abuse, including Medicare-covered home health, laboratory, imaging, DMEPOS (durable medical equipment, prosthetics, orthotics and supplies), and specialist services. One PPACA provision, Section 6406, requires the maintenance of ordering and referring documentation for at least 7 years from the date of the order, referral, certification, or service. These requirements to maintain documentation for this period become effective July 6, 2010. Existing record retention policies may already cover this requirement. NPs reassigning the right to bill for their services to entities such as employers, medical groups, or health care facilities should consider discussing with those entities how this documentation will be maintained. Both written and electronic documentation relating to orders or referrals, including claims, must be maintained and made available to CMS or a Medicare contractor on request. In addition