Health Information Management

Healthcare News: CMS issues additional clarification of physician supervision requirements

JustCoding News: Outpatient, June 16, 2010

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On May 28, CMS further clarified in Transmittal 128 in the Medicare Benefit Policy Manual the physician supervision requirement under the incident-to benefit as well supervision of diagnostic tests. CMS states:

While physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives only require physician supervision included in any collaboration or supervision requirements particular to that type of practitioner when they personally perform a diagnostic test, these practitioners are not permitted to function as supervisory “physicians” for the purposes of other hospital staff performing diagnostic tests.

Transmittal 128 also provided additional guidance regarding the term “immediately available:”

Immediate availability requires the immediate physical presence of the physician or nonphysician practitioner. CMS has not specifically defined the word “immediate” in terms of time or distance; however, an example of a lack of immediate availability would be situations where the supervisory physician or nonphysician practitioner is performing another procedure or service that he or she could not interrupt. Also, for services furnished on-campus, the supervisory physician or nonphysician practitioner may not be so physically far away on-campus from the location where hospital/CAH outpatient services are being furnished that he or she could not intervene right away.

CMS also outlined the credentials, knowledge, skills, ability, and privileges that the supervising provider must possess to qualify to perform a particular service or procedure.

Access MLN Matters article MM6996 to learn more.



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