07/12/2017

Palmetto Clarifies Hospice NP Billing

Palmetto has changed their position on billing for nurse practitioner (NP) services and, as a result, they contacted LeadingAge Ohio to ask us to retract the “You Asked/We Answered” article that was in the March 2, 2017 newsletter regarding hospices billing for NP services.  Palmetto has done further research and now asserts that the ONLY time a hospice can bill for Nurse Practitioner (NP) services is when the patient has selected the NP as their attending physician (CFR 42.418.304 (e)(1) Payment for physician and nurse practitioner services).

Therefore, if a hospice is having an NP visit and manage the care of patients in a hospice inpatient unit, but the patient has not selected the NP as their attending physician, the hospice may not bill for those NP services. According to the Conditions of Participation:

CFR 42.418.3 Definitions - Attending physician means a—

(1)(i) Doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs that function or action; or

(ii) Nurse practitioner who meets the training, education, and experience requirements as described in §410.75 (b) of this chapter.

(2) Is identified by the individual, at the time he or she elects to receive hospice care, as having the most significant role in the determination and delivery of the individual's medical care.

Palmetto suggests that if a hospice provider has been billing for NP services and the hospice has become aware the patient/representative has not selected the NP as their attending physician, they should stop billing for those services immediately. Providers will then need to make a decision on what to do with past NP claims that were billed, knowing that Medicare has the right to review processed claims up to 4 years back. If a provider is aware of a payment that was made in error for any services, they would be required to repay Medicare either by adjusting the claim(s) or submit the money back to CMS through the voluntary refund process.  A voluntary refund can be submitted through the eServices Online portal or by completing the voluntary refund form that can be accessed on the Palmetto GBA website.

**NOTE** The form currently lists only four of the states in the service region not including Ohio. SC is the region in which the claims process, so please mark SC for now. If they update the form, LeadingAge Ohio will notify members.

Palmetto GBA sincerely apologize for any confusion this may have caused.  Questions may be directed to Anne Shelley, Director of Home Health and Hospice Regulatory Relations at ashelley@leadingageohio.org.