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Advanced Practice Nursing/Physician Assistant (APN/PA)

Medicare Learning Network=

This web page is for Medicare fee-for-service Advanced Practice Nurses and Physician Assistants who provide services to Medicare beneficiaries.

Medicare Learning Network (MLN) Spotlights

Go to the What's New page for the latest MLN products and announcements!  Check it often!  (Scroll to the bottom of this page to the "Related Links Inside CMS" section and click on the What's New link)

Web-Based Training Program

"Advanced Practice Nurse/Physician Assistant Web-Based Training Program" – This Medicare APN/PA web-based training is composed of the Introduction and the following sections: Certified Registered Nurse Anesthetist (CRNA); Clinical Nurse Specialist (CNS); Nurse Practitioner (NP);

Certified Nurse-Midwife (CNM); Physician Assistant (PA); and

Additional Information. Each of the above lessons open separately, and describes the roles and reimbursement rules that apply to CRNAs, CNSs, NPs, CNMs or PAs who bill for services provided to Medicare beneficiaries. The sections that are part of the 'Additional Information' lesson detail topics that apply across-the-board to any or all APN/PAs.

The primary purpose of this web-based training is to:

  • Provide definitions of the Advanced Practice Nursing/Physician Assistant provider types;
  • Outline qualifications of the Advanced Practice Nursing/Physician Assistant provider types;
  • Describe collaboration/supervision requirements for Advanced Practice Nursing/Physician Assistant Medicare reimbursement;
  • List the Medicare billing requirements for Advanced Practice Nursing and Physician Assistants; and
  • Identify links to Medicare manuals and other resources.

See the Related Links Inside CMS section below to access the training program.

Internet-Only Manuals (IOM)

Day to day program operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives.  The IOM is used by CMS program components, contractors, and State survey agencies to administer CMS programs.  (Scroll to the bottom of this page to the Downloads section; click on Internet-Only Manuals to access links to the IOM specific chapters related to APN/PA.)

CMS Transmittals, MLN Articles, Job Aids

CMS uses transmittals, MLN Matters Articles, and job aids to communicate new or changed policies or procedures that will be incorporated into the CMS Online Manual System.  (Scroll to the bottom of this page to the Downloads section; click on CMS Transmittals, MLN Matters Articles, and Job Aids to access links to APN/PA specific transmittals, articles and job aids.)

Code of Federal Regulations

To access the Code of Federal Regulations, locate the link to the GPO website in the "Related Links Outside CMS"

Survey and Certification

Policy and Memos to States and Regions – See the Related Links Inside CMS below.

Enrollment Procedures for Non-Physician Practitioners

A "Medicare Enrollment for Physicians, Non-Physician Practitioners, and Other Health Care Suppliers" publication and the Medicare Enrollment Application can be found in the Downloads section below

Physician Quality Reporting Initiative (PQRI)

On December 29, 2007, the President signed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), which authorized the continuation of the Physician Quality Reporting Initiative (PQRI) for 2008 and 2009.  

The financial incentive for eligible professionals who successfully report the designated set of quality measures is 1.5% of total allowed charges for covered services payable under the Medicare Physician Fee Schedule (PFS) during the reporting period.  Financial incentives earned for 2008 reporting will be paid in mid-2009 from the Federal Supplementary Medical Insurance (Part B) Trust Fund.  The 1.5% financial incentive and its funding source are the same as for 2007.

For additional information on the Physician Quality Reporting Initiative, see the Related Links Inside CMS section below.

DMEPOS Competitive Bidding

PROGRAM OVERVIEW

Section 1847 of the Social Security Act mandates that competitive bidding payment amounts replace the current Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule payment amounts for selected items in selected areas. The intent is to improve the effectiveness of the Medicare methodology for setting DMEPOS payment amounts, which will reduce beneficiary out-of-pocket expenses. The Medicare Modernization Act of 2003 (MMA), Section 302, established these requirements for a new competitive bidding program for certain DMEPOS.

This program changes the way that Fee-For-Service (FFS) Medicare pays for these items under Part B of the Medicare program by using bids submitted by DMEPOS suppliers to establish payment amounts. The MMA required the Competitive Bidding Program to be phased in beginning in 10 of the largest Metropolitan Statistical Areas (MSAs). The new payment amounts will be effective on July 1, 2008 for these 10 areas. In 2009 the program will be expanded into 70 additional MSAs and into additional areas thereafter.

For additional information on the DMEPOS Competitive Bidding Program, see the Related Links Inside CMS section below.

National Provider Identifier Standard (NPI)

The NPI is here. The NPI is now. Are you using it?

Overview

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.

Beginning May 23, 2007 (May 23, 2008, for small health plans), the NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered entities may invoke contingency plans after May 23, 2007.

If you are a health care provider who bills for services, you probably need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy. Getting an NPI is free. The first step is to get your NPI. If you delay applying for your NPI, you risk your cash flow and that of your health care partners as well.

For additional information on the National Provider Identifier Standard, see the Related Links Inside CMS section below.

Part D Drug Coverage

The Medicare Modernization Act legislation provides seniors and people with disabilities with the first comprehensive prescription drug benefit ever offered under the Medicare program, the most significant improvement to senior health care in nearly 40 years.

See the Related Links Inside CMS section below to download Educational Products for Health Care Professionals.

National Correct Coding Initiative

CMS developed the Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.  

See the Related Links Inside CMS section below to download the CCI Edits and Manual.

Downloads

Advanced Practice Nurse/Physician Assistant PowerPoint Presentation [PPT ZIP, 1.2MB]

Additional Information PowerPoint Presentation [PPT ZIP, 2.4MB]

Internet Only Manuals (IOM) [PDF, 15KB]

CMS Transmittals, MLN Articles, Job Aids [PDF, 26KB]

Enrollment Procedures for Non-Physician Practitioners [PDF, 25KB]

Professional Associations [PDF, 25KB]

Related Links Inside CMS

APN/PA Web-based Training Program

DMEPOS Webpage

MLN What's New

Drug Coverage

Survey and Certification General Information

Certification and Compliance

Documentation Guidelines for E&M Services

SNF Consolidated Billing

Quarterly Provider Updates

NPI Viewlet

National Correct Coding Initiative

Related Links Outside CMSExternal Linking Policy

Third Party Reimbursement for Physician Assistants

42 CFR 410.77

Medicare Payment to Non-Physician Practitioners

Medicare Coverage of Non-Physician Practitioners

 

Page Last Modified: 07/10/2008 9:48:42 AM
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