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The American Medical Association (AMA) and 49 of the country’s leading medical organizations have charged that the Health Care Financing Administration (HCFA) encourages advance practice nurses to practice beyond legally authorized safeguards.
A petition from the alliance was delivered in July to Medicare officials calling for implementation of a process in which nurse practitioners (NP) and clinical nurse specialists (CNS) would have to work in collaboration with a physician in accordance with each state’s legally authorized practice requirements.
The organizations charge that HCFA has made no attempt to reinforce the requirements and has no system in place to ensure that patients are protected from the possible consequences of those who overstep their professional expertise.
"Proper oversight of the practice requirements placed on advance practice nurses is crucial to ensure access to comprehensive health care services, patient safety, and confidence in the health care system. HCFA must be accountable to the law and should not encourage NPs and CNSs to practice without these important safeguards in place," says AMA president Randolph D. Smoak, Jr.
The organizations called for four actions:
1. Implement a system that ensures Medicare payments are made only for services that are provided in collaboration with a physician and within the state law’s scope of practice requirements.
2. Limit distribution and renewal of Medicare billing numbers only to those advanced practice nurses who comply with the laws.
3. Issue detailed instructions to Medicare carriers on implementation on a system to ensure compliance.
4. Conduct an immediate audit, followed by future periodic audits, to ensure that Medicare payments are made only to NPs and CNSs for services furnished in collaboration with a physician and within the law.