Medlearn
Matters…Information for Medicare
Providers
(Issued by the Centers for
Medicare & Medicaid
Services)
|
MMA-Nurse
Practitioners as Attending Physicians in the Medicare
Hospice Benefit
Implementation Dates:
For
providers billing Local Part B carriers, and Local Part B
carriers, for all applicable requirements, June 28,
2004.
For providers billing intermediaries, use of the GV
modifier is to be implemented June 28, 2004, per the
revised Medicare Claims Processing Manual (Pub. 100-04),
Section 30.2 (Payment Rates).
For intermediary billing and systems, for all other
applicable requirements, October 4, 2004.
| NOTE: This transmittal
replaces Pub. 100-04, Transmittal 205, which was
issued on June 15, 2004. The manual instruction has
been modified in Chapter 11 (Processing Hospice
Claims), Section 40.1.3 (Attending Physician
Services). All other information remains the
same. |
Provider Types Affected
Nurse
practitioners, hospices
Provider Action Needed
Impact to You
Nurse practitioners and hospices should note that nurse
practitioners are being added to the definition of an
attending physician for beneficiaries who have elected
the hospice benefit.
What You Need to Know
Beginning
December 8, 2003, Medicare pays for services provided by
nurse practitioners to Medicare beneficiaries who have
elected the hospice benefit and have selected a nurse
practitioner as their attending physician.
What You Need to Do
Refer to the Background and Additional
Information sections of this instruction for more
information regarding these changes.
Background
This instruction
implements Section 408 of the Medicare Prescription Drug
Improvement and Modernization Act of 2003 (MMA), which
amends the Social Security Act (Section 1861(dd)(3)(B))
and (Section 1814(a)(7) to include nurse practitioners in
the definition of an attending physician for
beneficiaries who have elected the hospice benefit.
Beginning December 8, 2003, Medicare pays for
services, with the exception of certifying the terminal
illness with a prognosis of six months or less, if the
illness runs its usual course, provided by nurse
practitioners to Medicare beneficiaries who have elected
the hospice benefit and have selected a nurse
practitioner as their attending physician. A physician
will be required to certify the terminal illness and
six-month prognosis.
Hospice agencies will bill their Regional Home Health
Intermediary (RHHI) for attending physician services
performed by a nurse practitioner employed by or under
contract to the hospice agency. Also, nurse practitioners
providing attending physician services, who are not
employed by or under contract with a hospice agency, will
bill the Medicare Local Part B carrier.
Medicare Local Part B carriers and intermediaries will
pay for these physician services rendered by nurse
practitioners on or after December 8, 2003, at the lesser
of actual charges or 85 percent of the physician fee
schedule.
Instructions for care plan oversight for this
provision will be provided under separate
instruction.
Implementation
Instructions/Dates
Medicare carriers have
been instructed to search for and reopen denied claims
for professional services of nurse practitioners serving
as the hospice beneficiary’s attending physician
that were billed with the GV modifier and where the
services were furnished on or after December 8, 2003.
Where such services were not billed with the GV
modifier, Medicare carriers will not
reopen the claims unless the nurse practitioner
brings such claims to the attention of the carrier. If
the nurse practitioner prefers, they can rebill such
services rendered on or after December 8, 2003, with the
GV modifier to have the claims reprocessed.
RHHIs will accept all claims for attending physician
services performed by a nurse practitioner in a hospice
on or after December 8, 2003.
Hospice agencies are no longer required to submit
copies of Notices of Election (NOEs) to Medicare
carriers; however, when such agencies
bill RHHIs, the hospice agency should continue submitting
the NOEs to the RHHIs.
The implementation date for this instruction is June
28, 2004 for providers who bill Local Part B
carriers.
For providers billing intermediaries, use of the
GV modifier is also to be implemented on June 28,
2004, as presented in the Medicare Claims Processing
Manual update in the transmittal, section 30.2, Form
Locator (FL) 42, Revenue Code 0657.
Related Instructions
The
following Internet Only Medicare Manuals (IOM) have been
edited with revised and new sections to reflect the
requirements to implement section 408 of the MMA.
- The Medicare Claims Processing Manual (Pub. 100-4),
Chapter 11 (Processing Hospice Claims)
- The Medicare Benefit Policy Manual (Pub. 100-2),
Chapter 9 (Coverage of Hospice Services Under Hospital
Insurance).
Additional Information
The
official instruction (CR 3226) issued to your
carrier/intermediary regarding this change may be found
by going to:
http://www.cms.hhs.gov/Transmittals/
From that Web page, look for CR 3226 in the CR NUM
column on the right and click on the file for that
CR.
If you have any questions, please contact your
carrier/intermediary at their toll-free number, which may
be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf
Disclaimer
Medlearn Matters articles are
prepared as a service to the public and are not intended
to grant rights or impose obligations. Medlearn Matters
articles 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.
For more information, visit the Medlearn Matters Web
page at: http://www.cms.hhs.gov/MedlearnMattersArticles/
Related Change Request (CR) #: 3226
Medlearn Matters Number:
MM3226
Related CR Release Date: September 24, 2004
Related CR Transmittal #:
304
Effective Date: December 8, 2003
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