Frequently Asked Questions (FAQ)

What is a Nurse Practitioner ?

A nurse practitioner (NP) is a registered nurse who has received specialized training (often at a graduate level) in diagnosing and treating illnesses and providing health care maintenance. Many are family nurse practitioners, and some specialize in other areas, including:

Where do NPs work ?

NPs work in all 50 states and Washington, DC, in many health care settings. They can work independently in health care offices or in collaboration with physicians; they also may work in clinics, hospitals, outpatient facilities, nursing homes, schools, business, correctional facilities, home health care agencies, or long-term care facilities.

What are NPs qualified to do ?

As health care providers, NPs are trained and qualified to:

What does NP do in long-term care ?

Why choose an NP ?

NPs will take the time to assess how your lifestyle affects your health. NPs work with their patients to prevent illness and promote healthy lifestyle choices. They concentrate on early detection of illness and emphasize disease prevention by providing education for patients.

Do NP or PA orders need to be countersigned by a Physician ?

The answer is “No”, as long as the NP or PA is working within accepted “Standardized Procedures” approved by a Collaborating Physician and the facility. The Attending is responsible, however, to sign off on the overall plan of care during regulatory required visits. We (HCFA) believe that, to the extent feasible, the regulation should be written in a manner that allows the effective utilization of NPs in the nursing home setting.

Does the Nurse Practitioner need an order from the Attending Physician to see a patient ?

No. There is no requirement for an order. The Practitioner has his or her own UPIN number and works independently in association with a Collaborating Physician who may or may not also be the Attending Physician. Treatment plans are developed in coordination with the Attending Physician to assure a cooperative and collegial relationship.

May a Practitioner perform an Initial (Admission)NF or SNF “Regulatory” visit ?

Under federal regulation, since a Practitioner may do any visit that is not required to be performed by an MD or DO personally, the Practitioner may do any “Regulatory” Assessments and Subsequent visits on patients admitted to a Nursing Facility / non-skilled bed. A Practitioner cannot, however, perform and bill for the Initial Regulatory Visit on patients admitted to Skilled Nursing Facility / Part A bed.

May a Practitioner certify or re-certify Medicare Part A covered SNF care ?

The Practitioners are no longer able to authorize the initial certification for a Medicare Part A stay. They may, however, still re-certify further Medicare Part A care.

May a Practitioner authorize PT, OT and Speech Therapy ?

Yes, these services may be authorized by a NP or a PA even though only a physician can actually order admission to a Skilled Nursing Care or certify Home Health Services. HCFA Transmittal No. B-98-47 Date NOVEMBER 1998.

May a Practitioner pronounce death ?

Yes, but only MD, DO or coroner may fill out the death certificate. Pronouncement and completion of the death certificate and State regulated activities and in virtually all States, the Practitioner is allowed to pronounce, but only the physician may complete the death certificate. If Practitioner is completing the summary, that service becomes part of the Discharge Day Service and the Practitioner can bill as a 99315 even though a physical examination was not part of the service.

What are Quality Indicators (QI’s) ?

Certain measurable parameters have been determined to be indirect measurements of the quality of care provided in a nursing facility. Some of these indicators are the number of residents who have:

What’s a sentinel event ?

There are certain clinical “outcomes” that the regulatory system has determined are of such negative significance that they are “life threatening” or reflect extremely poor facility care – among these are:

Thus, documenting these outcomes will lead to the facility facing heavy scrutiny and possibly extremely large fines. Orders such as “increase fluids”, “Turn patient every two hours” or “Get patient up for at least 4 hours a day” imply the facility is not providing good care to begin with. Address “nursing measures” verbally and if you have a significant concern, address with the Medical or the Director of Nursing

“IMPROVEMENT COMES ONLY THROUGH CHANGE”