HCFA Issues Final Rule for the Medicare Physician Fee Schedule for 2000


On November 2, 1999, the Health Care Financing Administration (HCFA) published its final rule with comment period for the Physician Fee Schedule for calendar year 2000. This rule establishes Medicare payment rates for providers eligible to bill for Part B Medicare services and makes several other changes affecting Medicare Part B payments. The final rule is effective Jan. 1, 2000. The final rule reflects few changes from the proposed rule that was issued in July. The final rule finalizes the NP qualifications as detailed in the July proposed rule. ANA provided comments to HCFA on the proposed rule supporting the proposed modifications to the nurse practitioner (NP) qualifications to directly bill Medicare for Part B services.

Final Rule for NP Qualifications

The nurse practitioner qualifications require progressively enhanced qualifications but provides lead time for experienced nurse practitioners to obtain and maintain a Medicare billing number under the earlier nurse practitioner qualifications which did not require a master's degree. The final rule also includes a transition time period to enable nurse practitioners applying for the first time for a Medicare number to achieve national certification or earn a master's degree. (These revised NP qualifications would replace the required NP qualifications that were published in the Federal Register, November 2, 1998).

Required NP Qualifications

The final rule will revise 42 CFR Sec. 410.75 (b) so that for Medicare Part B coverage of his or her services a nurse practitioner must:
  1. (i) Be a registered professional nurse who is authorized by the State in which the services are furnished to practice as a nurse practitioner in accordance with State law; and (ii.) Be certified as a nurse practitioner by a recognized national certifying body that has established standards for nurse practitioners; or
  2. Be a registered professional nurse who is authorized by the State in which the services are furnished to practice as a nurse practitioner in accordance with State law and have been granted a Medicare billing number as a nurse practitioner by December 31, 2000; or
  3. Be a nurse practitioner who, on or after January 1, 2001, applies for a Medicare billing number for the first time and meets the standards in paragraph (b) (1) (i) and (b) (1) (ii); or
  4. Be a nurse practitioner who, on or after January 1, 2003, applies for a Medicare billing number for the first time must possess a master's degree in nursing and meets the standards for nurse practitioners as defined in paragraphs (b) (1) (i) and (b) (1) (ii).

Grandparenting Period

The final rule will allow nurse practitioners, who meet the earlier established requirements, to apply for a Medicare number for a period of time ending on December 31, 2000. The earlier criteria were set forth in regulations under the rural health clinic conditions for certification (42 CFR 491.2) and as part of the Medicare Carriers Manual, Section 2158. The new qualifications beginning January 1, 2000, would apply only to those NPs applying for Medicare numbers for the first time. Therefore, an NP would be subject only to the qualifications requirements under which he or she received the initial Medicare number.

Clinical Nurse Specialists

The required qualifications for clinical nurse specialists (CNSs) to participate as Medicare providers remain unchanged from those promulgated in the Medicare Physician Fee Schedule for 1999, as published in the Federal Register, November 2, 1998.

Diagnostic Tests

The preamble to final rule clarifies issues related to physician supervision of NPs and CNSs when performing diagnostic tests. The final rule revises 42 CFR Sec. 410.32 (b) concerning diagnostic x-ray and other diagnostic tests and add an exception at 42 CFR Sec. 410.32 (b) (2) to specify that Medicare will now permit diagnostic tests performed by NPS and CNSs (when authorized by state law) to be covered without a requirement for physician supervision.

In addition, the final rule adopts HCFA's proposed revision to 42 CFR 410.33 (a) which establishes criteria for the operation of independent diagnostic testing facilities (IDTFS), to include NPs and CNSs who perform diagnostic tests that the State authorizes them to perform in the list of entities that may be paid directly by Medicare.

Additional Changes

In addition to modifications to the NP qualifications and diagnostic tests, the final rule also sets out changes; discontinuous anesthesia time, prostate screening, and the CPT modifier-25. It also includes refinement of resource-based practice expense relative value units (RVUs) which base physician practice expenses on actual resources used to provide services rather than on physicians' historical charges. One of the changes proposed is the removal of clinical staff time from the fee schedule when Part B provider bring their own clinical staff to the inpatient setting. HCFA claims that this would result in paying twice for the same service (hospitals are paid for clinical staff under Medicare Part A). In addition, HCFA believes that it is not typical for most Part B providers to use their own clinical staff in facilities.

Additional information is available at www.cms.hhs.gov/apps/media/press/release.asp?Counter=138

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