Session - 1
Billing for Nurse Practitioners in 2022 – During the PHE and with New Split Shared Guidelines
As the physician shortage continues to increase, nurse practitioners are looked at more and more as a solution and valuable commodity as alternative providers. Observational studies have shown that patients often prefer Nurse Practitioners to Physicians in a Primary Care setting.
These individuals who were highly trained nurses, chose to receive additional training to become nurse practitioners (NP). State Scope of Practice defines what they can do which is not pandemic public health emergency (PHR) times. In some states, prescriptive authority is an issue, in other states the level of supervision for patient care is higher than published Medicare standards. Knowing what your State requirements are is a must as a foundation for the knowledge you need to build your compliant practice plan for the use of your Nurse Practitioner. Other factors in building (or evaluating your practice plan include how to utilize NP’s in differing healthcare settings and analyzing the varying levels of supervision required at these locations. Collaborative Care agreements also need to be in writing and analyzed and updated periodically, especially with any practice or job description changes.
Lastly, the significant changes in Split Shared billing for 2022, need to be understood at a very detailed level. Compliance with these new policy changes for Medicare and all insurances that follow Medicare rules for these services is a must! The changes to Split Shared services, also affect both Critical Care services and teaching services, so significant learning is needed to make sure your practice plan doesn’t collapse like a house of cards under the weight of an audit! One more question, did Medicare’s policy change to Physician Assistant’s services have any effect on Nurse Practitioner services? Join this webinar by our expert speaker Jill M Young to understand these changes.
Webinar Objectives
- Understanding state scope of practice differences and how to look up yours
- Understanding Medicare’s “incident to” billing concept and how it has changed during the PHE
- What documentation is needed to meet the requirements of it
- Understanding Medicare’s concept of direct billing and what that means for the NP
- Understanding why Medicare’s Physician’s Relative Value Fee Schedule Data Base is so valuable
- Understanding what payment policies are for Nurse Practitioners
- Understanding the significant changes to Split Shared Billing for 2022
- What has all this to do with other commercial insurances?
Webinar Agenda
- State Scope of Practice – What is it? Where to Find it? How do understand it?
- Introduction to Medicare’s Policy for Nurse Practitioner’s Billing – (payment policies, collaborative agreements)
- Introduction to Medicare’s policies for Incident to and Direct Billing (supervision requirements)
- Understanding Medicare’s Physician’s Relative Value Fee Schedule DataBase
- Medicare and Nurse Practitioners During the Public Health Emergency (PHE)
- Changes to policies in 2022 (Split Shared Visits, Critical Care, Defining Teaching Services, Diagnostic Testing. Changes to Physician Assistant’s Services)
Webinar Highlights
- State Scope of Practice Restrictions
- Incident To and Plan of Care Restrictions
- Levels of Supervision and Temporary Changes during the PHE
- Commercial insurances diverse policies
- Split Shared Changes in 2022
Who Should Attend
- Billers
- Officer Manager
- Office Administrators
- Practice managers
- Nurse Practitioners
Session - 2
Nursing: CMS CoP Updates 2022
There were multiple changes to the hospital nursing chapter of the conditions of participation (CoPs) in 2020. However, many of those changes are still awaiting interpretive guidelines and survey procedures. In late 2020, CMS made changes to the section in response to COVID-19 pandemic for “hospital at home” facilities.
This webinar will discuss plans of care, staffing, policy changes, when a RN is required in an outpatient department, documentation, supervision, nursing leadership, verbal orders, antibiotic stewardship program requirement and more.
CMS has issued deficiency reports which includes which are the most problematic standards for hospitals. The nursing services has been cited over 6,300 times according to the most recent report. This is a must attend program for any chief nursing officer, clinical nurse or nurse supervisor or person interested in ensuring compliance with the CMS hospital conditions of participation in nursing. This must attend program and will discuss the deficiencies and how hospitals can ensure compliance.
There are many changes in the past to this section include timing of medications, standing orders, soft wrist restraints and restraint reporting, plan of care, verbal orders, blood transfusions, IV medication, compounding, BUD, antibiotic stewardship program, safe injection practices, self-administration of medications and drug orders.
Every hospital that accepts Medicare and Medicaid reimbursement must follow the CMS (Center for Medicare and Medicaid Services) Conditions of Participation (CoPs) and it must be followed for all patients. This program will cover the nursing services section in the hospital CoP manual. Facilities accredited by the Joint Commission, Health Care Facility Accreditation Program, CIHQ, and DNV Healthcare must also follow these regulations.
This webinar will also reference other important sections that all nurses should be aware that are found outside the nursing services section such as the revised discharge planning standards, medication standards, revised history and physicals, visitation, restraint and seclusion and grievances, and privacy and confidentiality. CMS issued the privacy and confidentiality memo, safe injection practices memo, humidity memo, and insulin pen memo.
Webinar Objectives
- Recall that CMS has a section on nursing services that every hospital must follow even if accredited
- Describe the three different timeframes for which all medications must be administered
- Discuss that nursing care plans are a frequently cited area by CMS
- Recall that verbal orders must be signed off and must include both a date and time
Webinar Agenda
- Introduction into the CMS hospital CoPs
- General information on CMS including online access and email contact for CMS to ask questions
- CMS deficiency reports and problematic standards
- Changes to medication management, IV, blood, and opioid safe use
- Final changes under the Hospital Improvement Rule to nursing
- ISMP safe injection practices
- CMS memos of interest
- Legionnaire’s
- Reporting to the PI system
- Humidity in the OR
- CDC resources on preventing healthcare acquired infections (HAI)
- Nursing Services and 24 hours services
- RN on duty – recent update
- Integrated with hospital wide PI program
- Organizational chart and nursing
- Chief Nursing Officer (CNO) responsibilities & requirements
- CNO approval of nursing policies
- Staffing and delivery of care
- 24-hour nursing services and supervision
- RN to evaluate to care of all patients
- Nursing care plans
- Changes to the plan of care
- Agency nurse requirements
- Medication administration
- Order required for all medications
- OCR Section 1557 and 2020 changes
- BUD, compounding sterile preparations (CSP)
- Standing orders and protocols
- Three medications timing changes
- Protocols, standing orders, order sets
- Requirements for complete drug order
- Verbal orders
- Blood transfusions and IV medications changes
- Self-administered medications
- 1135 Waivers for sections addressed
Other important sections nurses should be aware of:
- Restraint and seclusion changes
- Grievances
- Medication policies
- Visitation
- History and physicals
- Discharge planning revised standards
Who Should Attend
- Chief nursing officer
- All nurses
- Nurse managers/supervisors
- Nurse educators
- HIM staff
- Compliance officer
- Chief of medical staff
- Medical staff coordinator
- Risk manager
- Patient safety officer
- Senior leadership
- COO
- Hospital legal counsel
- QAPI director
- Joint Commission coordinator
- Regulatory officers
- Physicians
- Education department staff
- Board members
- Director of health information management
- Audit staff
- Others responsible for compliance with hospital nursing regulations including documentation compliance.
