Nursing Services
Medicare Benefit
Policy Manual (CMS Pub. 100-02) Ch. 9 §40.1.1
Nursing care services must be provided by or under supervision of a registered nurse, and must be reasonable and necessary to the treatment of the beneficiary's illness or injury. The nurse may serve as a team leader for the coordination of the beneficiary's care of the Intermediary Group (IDG). The nurse's documentation is critical to show the continued medical necessity of hospice services by documenting objective nursing and functional assessment.
Services provided by a nurse practitioner (NP) who is not the beneficiary's attending physician, are included under nursing care. This means that, in the absence of an NP, 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.
Reviewed: 12.08.21