Nurse practitioner w/o certified Physician

Our agency is providing care to a Medicare HMO patient with the initial order referred by his Endocrine's doctor; in the middle of the certification, the patient was transferred to an office of the nurse practitioner who is working without of any physician certified supervision. The question is for home health agency is allow to provide services to the patient who is under the care of nurse practitioner only?

I appreciate any input on this matter


  • I've been having issues with this. But, can a nurse practitioner practice medicine with the supervision of a licensed physician?

    Currently, I am having my clients get a licensed physician as I've had several Rejections from Medicare for these claims with an NPI for a Nurse Practitioner.

    Hope someone answers.

    Thanks Claudia,

    Stephen Dixon
    Dixon Healthcare Billing Solutions, Inc.

  • Only MD, DO & DPMs can sign POC.

  • edited May 2017
    The supervising physician needs to co-sign plan of care.

    Liz Pearson
    Pearson & Bernard PSC
    178 Barnwood Dr.
    Edgewood, Ky 41017
    859-655-3700 (w) 859-655-3703 (f)

  • Thanks, Stephen and Dania for your input
  • edited May 2017
    There aren't always supervising physicians. In many states they work 100% independently. But can't order home health.

    Susan G. Johnsen, RN, MSN, COS-C
    LLUMC Home Health Education & Informatics Specialist
    ph: 909 558 3285

  • While this topic is being discussed - We are in the habit of obtaining the signature of and MD, DO etc, on all certifications/POCs, and currently, any follow up orders that must be written. However is this required for follow up orders? Are NPs, Pas, etc, allowed to sign follow up orders as long as the certification and POC are signed by the supervising physician? Thanks in advance for any input!


  • Thanks Susan!

    If they do have a supervising physician, and that MD has signed the cert/POC, are the NPs then allowed to sign any follow up orders that may be required?


  • Our surveyors have told us that we can't even have the appearance of accepting an order from a NP or PA.


  • A physician must write the orders for the plan of care and must sign any changes in the plan so no NPs cannot solely sign any follow up orders which are considered a change in the plan of care. The CFR specifies only 1 function that a nonphysician practitioner may perform for patients being cared for by a home care agency. That function, care plan oversight, does not include ordering medications or treatments or discontinuing home care. Unlike some newer statutes, the statutes governing HHAs have not been changed in recent years to include medical practitioners other than physicians.

    Jackie Bush, RN, MBA, CPHQ, COS-C
    Director of HCMC HH & Hospice
    311 E. Wood St.
    Paris, TN. 38242
    731-642-7600 (P) * 731-644-9639 (F)

  • Jackie and Karen, I appreciate your responses.

    We have been argued with by the physicians, of course (simply for lack of knowledge of the rules of HH) but it was just brought to my attention this week that our Assistant DON was advising our office manager that PAs/NPs etc can sign follow up orders as long as the cert/POC was/is signed by an MD. I didn't think this was right. Appreciate the clarification!


  • edited May 2017
    Not in a certified agency, no.

    Susan G. Johnsen, RN, MSN, COS-C
    LLUMC Home Health Education & Informatics Specialist
    ph: 909 558 3285

  • refer to the COP's regarding orders - NP's and PA's are specifically excluded in the phrasing. As compared to the face to face COP where they are included

  • If you are a hospice provider as well, nurse practitioners can give and sign interim orders for hospice clients, they cannot, however, sign the certificate of terminal illness. Maybe your employee was thinking of this?

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