Pre-Test/Post-Test Questions

1
Pre-Test/Post-Test Questions

• Regulatory and Coding Issues
• Valisa Saunders APRN, GNP-BC

2
What legislation first authorized Advanced
Practice Nurses Physicians Assistants to do
regulatory or required visits in SNFs?

• A. OBRA 1987
• B. BBA, 1997
• C. MMA, 2003
• D. Medicare 1965

ANSWER A The Omnibus Reconciliation Act of 1987
3
What legislation authorized direct reimbursement
to APNs/PAs for Medicare Part B services?

• A. OBRA 1987
• B. BBA, 1997
• C. MMA, 2003
• D. Medicare, 1965

ANSWER B Balanced Budget Act, 1997
4
What legislation authorized NPs only, to act as
attending for Hospice patients ?

• A. OBRA 1987
• B. BBA, 1997
• C. MMA, 2003
• D. Medicare, 1965

ANSWER C Medicare Modernization Act
5
The Annual Nursing Facility Assessment was
previously coded as a Comprehensive Assessment
coded as a 99301. What code is used now?

• A. 99304 (Initial)
• B. 99305
• C. 99309
• D. 99318

ANSWER D Requires Comprehensive History and
Exam low to moderate medical decision making
(MDM)
6
Which CPT set of codes would the APN (or MD) use
for medically necessary care visits?

• A. 99304-99306
• B. 99315-99318
• C. 99307-99310
• D. 99311-99313
• E. None of these

ANSWER C as of January 1, 2006 Codes 99307-99310
replaced 99311-99313
7
What Subsequent Care CPT code would be generally
used for 30 and 60 day required visits by the
APN?

• A. 99304 (Initial)
• B. 99307
• C. 99309
• D. 99318

ANSWER C, review of three or more chronic
conditions (interval history) counts as the HPI
for Required visits
8
What Set of CPT codes are used for INITIAL
visits for SNF patients by the physician?

• A. 99304-99306
• B. 99307-99310
• C. 99315-99318
• D. 99301-99303

ANSWER A, Only the MD can use 99304-99306 for
SNF patients Initial visits
9
Can the APRN ever use CPT codes 99304-99306
INITIAL visits? (short answer)
ANSWER Yes, but only for Nursing Facility
patients (NF), in states that have adopted laws
or rules allowing APNs not employed by the
facility to do initial visits as allowed by CMS
rules in 42 CFR 483.40 (f)
10
Initial Visit Codes require how many key elements
(history, exam, medical decision making mdm at
the level coded?

1. Two out of three key elements
2. Two out of three key elements if the visit takes
   an hour or more
3. Three out of three key elements
4. Three out of three key elements if the visit
   takes an hour or more

ANSWERC, Time elements have not been established
for LTC CPT codes (2006)
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Subsequent Care Codes 99309 and 99310 require how
many key elements at the level coded?

1. Two out of three key elements
2. Two out of three key elements if the visit takes
   an hour or more
3. Three out of three key elements
4. Three out of three key elements if the visit
   takes an hour or more

ANSWER A , but would require moderate or high
level medical decision making
12
Which of the following Medicare providers can
sign the Medicare post-Hospital care SNF need
certification or recertification?

• Any Medicare provider with a UPIN
• MD
• NP/CNS employed by outside agency
• NP/CNS employed by facility
• E. PA employed by outside agency

ANSWER B C. APN employed by facility cant
sign any. APN not employed by facility CAN sign
all. PA cant sign any regardless of employment
status
13
Which of the following Medicare providers can
bill for the Medicare post-Hospital care SNF
need certification or recertification?

• Any Medicare provider with a UPIN
• MD
• NP/CNS employed by outside agency
• NP/CNS employed by facility
• E. PA employed by outside agency

ANSWER Nobody can bill for signing the
certification its for payment only. Bill for
medically necessary visits.
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Who can bill for the SNF patients Initial
Visit?

• Any Medicare provider with a UPIN
• MD
• NP/CNS employed by outside agency
• NP/CNS employed by facility
• E. PA employed by outside agency

ANSWER B MD only (see slide 8)
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True/false APNs that are employed by the
facility can do and bill required visits for SNF
patients.

1. True
2. False

ANSWER A TRUE for alternate required visits,
after the Initial visit by MD and delegated by MD
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T/F APNs employed by the facility are permitted
to perform other (than required) visits and write
orders based on these visits

1. True
2. False

ANSWER A. True. The BBA, 1997 gave this
authority independently of the required visit
language from the original enabling legislation
of OBRA, 1987.
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T/F APRNs employed by the facility that do
medically necessary visits need MD co-signatures
on their orders

1. True
2. False

ANSWER A. True - See memo from CMS dated Nov.
13, 2003.
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Can the APN do the 14 day required visit?

• Short answer question

ANSWER There is NO 14 day required visit. There
is a 14 day recertification for SNF payment to
the facility for the patient on Medicare
benefits. It does NOT require a visit.
19
The APN can order therapy for a NF patient, if

• A. Allowed by state laws
• B. If they are not employed by the facility
• C. If the patient has Medicare

ANSWER A While the BBA, 1997 authorized
payment for therapy ordered by an APN under
Medicare part B, the ordering of therapy is a
scope of practice issue for the APN, and legal
issue for the therapist. In some states the
therapist may not be authorized to take orders
from APNs until their practice act is amended.
20
How is the ability of the NP to do the required
visits in a SNF determined?

• A. By Federal Regulation
• B. By MD delegation
• C. By State LTC licensing laws
• D. A B
• E. None of these

ANSWER D, There may be other factors such as
facility or employer policy
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The CPT code 99318 is used

• A. To bill the Annual Nursing Facility Assessment
• B. In place of a required visit
• C. In addition to a 60 day required visit
• D. A B
• E. When a patient is re-admitted from the
  hospital

ANSWER D, You cant bill for both 99318 and a
subsequent care code on the same day. It should
be on the required visit cycle
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• Please tell me how you scored on your pre-test
  and what your background is. If you dont
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  for further clarification, or other questions.
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  content on the website.
• Mahalo, Valisa Saunders APRN, GNP-BC
• Honolulu, Hawaii
• Email Valisa_at_hawaii.rr.com