The Centers for Medicare and Medicaid Services has clarified that it pays nonphysician practitioners directly for services rendered in the hospital

Healthcare Financial Management, March, 2007

The Centers for Medicare and Medicaid Services has clarified that it pays nonphysician practitioners directly for services rendered in the hospital. According to CMS, carriers will pay for hospital professional services furnished by nurse practitioners and clinical nurse specialists when billed directly with their Medicare billing number or National Provider Identifier, once it becomes effective. Additionally, carriers will pay a hospital for these services when payment has been reassigned to the hospital. However, the hospital must bill for reassigned services under the NP's and CNS's Medicare billing number or NPI. For physician assistants' professional services furnished in the hospital, Medicare will pay the employer of the physician assistant if the service is billed under the PA's Medicare billing number or NPI.

Carriers will search and reopen claims submitted by NPs, CNSs, or employers of PAs that have been denied since Jan. 1, 2006, because claims listed a hospital setting as place of service. For employers whose claims were denied, carriers will search and reopen claims for dates of service on or after Jan. 1,1998. (Transmittal 1168)