NPs, CSNs Reimbursed for Physician Services Under New Medicare Laws

Medicare now will r e imburse nurse practi t ioners (NPs) and clini- cal nurse specialists (CNSs) for ser- vices that would be covered if provided by a physician. Under the new policy, "physicians' services" will include the following:

• Services that would be consid- ered a physician service if per- formed by a physician but are per formed by an NP or CNS col- laborating with a physician

• Services that the NP or CNS is authorized by state law to perform

These services are covered regard 2 less of geographic area. In addition, no separate provision exists for NP services provided in nursing homes.

Regarding r e imbursemen t fees, the new law reads, "The amounts paid shall be equal to 80% of (i) the lesser of the actual charge or 85 % of the fee schedule amount provided under section 1848, or (ii) in the case of services as an assistant at surgery, the lesser of the actual charge or 85 % of the amount that would otherwise be recognized if pe r fo rmed by a physician who is serving as an assis- tant at surgery."

Home Health Agency Freeze Lifted

With new protections in place to p revent fraud, including a new requirement for surety bonds to pro- tect consumers and the Medicare trust fund, the Depar tment of Heal th and Human Services in January lifted the mora to r ium on enrolling new

home health agencies (HHAs) in the Medicare program.

The new regulations require all H H A s serving Medicare beneficiaries to obtain surety bonds of $50,000 or 15% of annual Medicare payments received, whichever is greater. The rules also establish minimum capital requirements to make certain that new H H A s have enough funds to operate for at least 3 months before they start caring for Medicare patients.

Fur thermore , H H A s are being asked whether they have "re la ted business interests" before they are admi t ted into Medicare to help determine if they have a history of fraud and abuse and to ferret out questionable billing patterns. Also, H H A s must have provided quality care to at least 10 patients before being allowed to provide care to Medicare beneficiaries. Finally, home health care now must be billed based on where care is provided to close a loophole that allowed H H A s to pro- vide care in low cost rural areas but bill for it at higher urban rates where their offices were based.

Regulations should be issued this summer to require criminal back- ground checks for all home health aides and make other improvements in the condit ions of par t ic ipat ion that H H A s must follow to serve Medicare patients.

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Rapid Pneumonia Treatment Saves Lives

A Medicare study recently pub- lished in J A M A found that mortali ty rates are reduced 15% when patients with pneumonia receive antibiotic therapy within 8 hours of hospitaliza- tion. The records of 14,069 hospital-

ized Medicare patients with pneumo- nia in 3555 acute care hospitals nationwide were analyzed, and inves- t igators found that one in four patients did not receive antibiotics within the initial 8 hours.

Study Shows Cap on Medicare Rehab Funds Detrimental

A study sponsored by the National Association for the Support of Long- Term Care (NASL) evaluated the impact of a $1500 cap on rehabilita- tion services for Medicare beneficia- ries treated outside the hospital. The findings showed that nearly 15% of beneficiaries who need rehabilitation for debilitating conditions, such as stroke or hip fracture, are likely to exceed the $1500 limit. NASL President Larry Lane said, "The limit has the potential to shift patients from lower cost settings to higher cost hospital settings, driving total Medicare costs up and thwarting pro- ject cost savings. Congress should revisit the issue to preserve choice and quality of care for the oldest and sickest Medicare beneficiaries who need rehabilitation services."

Copies of the repor t may be obta ined by calling the NASL at (703) 549-8500.

AGS Endorses Consensus Statement on Anticoagulation Therapy

The American Geriatrics Society (AGS) has approved a consensus statement, "Effect ive Stroke Prevent ion in Atrial Fibrillation Requires Close Laboratory Monitor-

64 Geriatric Nursing Volume 19, Number 2