Nurse Practitioner Qualifications
This article appeared previously in The LINK.
Requirements are revised to make them less restrictive for experienced nurse practitioners and more restrictive for new nurse practitioners in future years.
For Medicare Part B to cover a nurse practitioner they must:
- Be a registered nurse authorized by the State and practicing in accordance with State law. -AND-
- Be certified by a recognized national certifying body.
-OR- - Be a registered nurse authorized by the State and practicing in accordance with State law and have a Medicare billing number by December 31, 2000.
-OR- - Be a nurse practitioner who applies for a Medicare billing number on or after January 1, 2001 for the first time and is State authorized and nationally certified.
-OR- - Be a nurse practitioner who applies on or after January 1, 2003 for the first time and has a Master’s Degree, is State authorized and nationally certified.
- Be certified by a recognized national certifying body.
CPT –25 Modifier
This article appeared previously in The LINK.
- Will be required for some diagnostic and therapeutic services
- Why? Every procedure has an inherent E/M component. -25 will show the E/M you are billing for is completely separate from the procedure.
- Won’t know which CPTs are involved in this new rule
- Rule won’t come into effect until at least October 1, 2000
Appeals By Phone
This article appeared previously in The LINK.
- Effective February 1, 2000
- Initial appeal
- 6 month deadline
- Answer while on phone
- Not reviewed by a physician
- Answer within 1-2 business days
- Carrier allowed to limit the number of appeals per call