FQHC Visiting Nurse Services - JE Part A

Descriptions of Visiting Nurse Services

Responsibilities:

• Provides skilled nursing services which are reasonable and necessary to diagnosis and treatment of patient's unique medical condition
• Skilled services are based on complexity of service, condition of patient and accepted nursing and medical practices
• Requires skills of a nurse to provide safe and effective care which continues to be a skilled service even if it is taught to patient, patient's family, or other caregivers
• Determination is made by physician based on condition of patient when services were ordered and what is reasonably expected to be appropriate treatment for illness or injury throughout certification period

Covered Services

The following requirements must be met:

• Patient is considered homebound
• FQHC is located in an area that has a shortage of home health agencies determined by Secretary
  • Written requests to CMS Regional Office (RO) can be made along with written justification that area it serves meets required conditions
• Services provided under a written treatment plan
• Nursing care is furnished on a part-time or intermittent basis only by a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN)
• Drugs and biologicals are not provided
• Home nursing visits before plan is put into writing are covered if authorized in writing by supervising physician

Treatment Plans

• Must be written and reviewed by a supervising physician, Nurse Practitioner (NP), Physician Assistant (PA), Clinical Nurse Midwife (CNM), Clinical Psychologist (CP), or Clinical Social Worker (CSW), as appropriate, at least once every 60 days
• Plan is terminated when no visit occurs during the 60-day period unless
  • Supervising physician recertifies within the 60-day period and indicates lapse
  • Documented intervals are predictable for treatment less frequent than 60 days
• Home nursing visits before plan is put into writing are covered if authorized in writing by supervising physician

Billing and Payment

Beginning with dates of service on or after April 1, 2016*:

• Line item date of service
• Type of Bill (TOB) 077X
• Revenue code 052X
• FQHC Prospective Payment System (PPS) HCPCS code G0466 or G0467
• Qualifying HCPCS code G0490 (*Added to the IOCE, on January 1, 2017)
• Paid FQHC PPS

Resource

• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 7 - homebound defined