National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Nurse Practitioner (NP) Services and Clinical Nurse Specialist (CNS) Services  

Provider Types Affected
Nurse practitioners (NP) and clinical nurse specialist (CNS) who bill Medicare Carriers and Medicare Administrative Contractors (A/B MAC) for services provided to Medicare beneficiaries  

What You Need to Know
In CR 5639, from which this article is taken, the Centers for Medicare & Medicaid Services (CMS) announces that their manuals are being updated by adding the National Board on Certification of Hospice and Palliative Nurses (NBCHPN) to the list of recognized national certifying bodies for NPs. This list will also provide the new name for the National Certification Board of Pediatric Nurse Practitioners and Nurses and provide the correct reference for the Critical Care Certification Corporation. This same list of recognized national certifying bodies for advanced practice nurses will be included under the manual instruction on CNS services.

Carriers and A/B MACs will enroll nurses, under the NP and CNS benefits, who meet all of the other NP or CNS qualifications; and are certified as practice nurses by any of the recognized national certifying bodies listed below, effective November 19, 2007.  

Background
Federal regulations that govern nurse practitioner (NP) services at 42 CFR 410.75 and those governing the clinical nurse specialists (CNS) services at 42 CFR 410.76 require that these advanced practice nurses be certified by a national certifying body that has established standards for NPs and CNSs.

CR 5639, from which this article is taken, announces that CMS is adding the National Board on Certification of Hospice and Palliative Nurses (NBCHPN) to the list of recognized national certifying bodies for NPs at the advanced practice level, located in the Medicare Benefit Policy Manual, Chapter 15 (Covered Medical and Other Health Services), Section 200 (Nurse Practitioner (NP) Services). CR5639 also announces the addition of this same list of recognized national certifying bodies for advanced practice CNSs in Section 210 (Clinical Nurse Specialist (CNS) Services) and in Chapter 10, Sections 12.4.5 and 12.4.8 of the Medicare Program Integrity Manual.

Effective November 19, 2007, the list of recognized national certifying bodies for NPs and CNSs at the advanced practice level is as follows:

• American Academy of Nurse Practitioners;
• American Nurses Credentialing Center;
• National Certification Corporation for Obstetric, Gynecologic and Neonatal Nursing Specialties;
• Pediatric Nursing Certification Board (previously named the National Certification Board of Pediatric Nurse Practitioners and Nurses);
• Oncology Nurses Certification Corporation;
• AACN Certification Corporation; and
• National Board on Certification of Hospice and Palliative Nurses.

Additional Information
You can find more information about NP and CNS services by going to CR 5639, which is in two transmittals located on the CMS Web site. As an attachment to transmittal R75BP ( http://www.cms.hhs.gov/Transmittals/downloads/R75BP.pdf ), you will find updated Medicare Benefit Policy Manual, Chapter 15 (Covered Medical and Other Health Services), Sections 200 (Nurse Practitioner (NP) Services) and 210 (Clinical Nurse Specialist (CNS) Services). As an attachment to transmittal R219PI ( http://www.cms.hhs.gov/Transmittals/downloads/R219PI.pdf ), you will find updated Chapter 10, Sections 12.4.5 and 12.4.8 of the Medicare Program Integrity Manual.

If you have any questions, please contact your carrier or A/B MAC at their toll-free number, which is available at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM5639
Related Change Request (CR) #: 5639
Related CR Release Date: August 17, 2007
Effective Date: November 19, 2007
Related CR Transmittal #: R75BP and R219PI
Implementation Date: November 19, 2007

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