Nursing care services Under Medicare hospice

Nursing Care

To be covered as nursing services, the services must require the skills of a registered nurse, or a licensed practical (vocational) nurse under the supervision of a registered nurse, must be reasonable and necessary to the treatment of the patient’s illness or injury.
Services provided by a nurse practitioner (NP) who is not the patient’s attending physician, are included under nursing care. This means that, in the absence of a nurse practitioner, a registered nurse (RN) would provide the service. Since the services are nursing, payment is encompassed in the hospice per diem rate and may not be billed separately regardless of whether the services are provided by an NP or an RN. The following are examples of some services that traditionally are provided by a registered nurse, which could also be provided by a nurse practitioner, for which separate payment is not made:
a. A patient with a terminal diagnosis of lung cancer complains of leg pain. In the absence of a nurse practitioner, a registered nurse would assess the patient.
b. Assessment of pain and or symptoms for the determination for the need of medications, other treatments, continuous home care, general inpatient care etc. In the absence of a nurse practitioner, a registered nurse would assess the patient.
c. Administration of medications through intravenous (e.g., PICC, central, etc.), intrathecal or any other means. In the absence of a nurse practitioner, a registered nurse would administer the medication.
d. Family counseling. In the absence of a nurse practitioner, a registered nurse, social worker or counselor would provide this service.
e. Providing a home visit visits for assessment or provision of care to a patient who is not his/her patient. In the absence of the nurse practitioner, the service would be provided by a registered or licensed nurse. Therefore the NP cannot bill separately for the service.