1. The following slides were part of the presentation at the 25 th annual Southwest Regional NP Symposium Angela Golden AANP Co-President American Association of Nurse Practitioners

2. July 1 st – require PHYSICIAN documentation WAIT WAIT – letter writing and visits with Medicare by provider groups Now delayed to October 1 st provision in the Affordable Health Care Act Will require physicians to document that a newly required face to face encounter (in the prior 6 months) occurred with the patient for certain types of DME The encounter can be done by an NP http://www.capwiz.com/aanp/issues/alert/? alertid=62722811 http://www.capwiz.com/aanp/issues/alert/? alertid=62722811 DME

3. Home Health AGAIN S. 1332: Home Health Care Planning Improvement Act of 2013 Sen. Susan Collins [R-ME] Schumer, Charles [D-NY] In finance committee and no one from Arizona is on this Why is this year different Senate subcommittees are asking for information from NPs AANP has two lobbyists now and increased staff for federal level BUT WE NEED YOU http://www.capwiz.com/aanp/issues/alert/?aler tid=62779806 http://www.capwiz.com/aanp/issues/alert/?aler tid=62779806

4. Incident to – beware!!! "Incident to" rules are unchanged continue to be limited to services strictly as a follow up to the physician’s plan of care MEDICARE IS LOOKING AT THIS FOR FRAUD YOU ARE RESPONSIBLE FOR WHAT YOUR BILLERS ARE SENDING IN Specifics limited to the office setting physician must still be on site cannot be with a new patient or with an old patient with a new problem In its 2012 work plan, Office of Inspector General intends to determine whether incident-to claims have a higher error rate than ordinary ones

5. Miscellaneous - CMS Attending in Home Health and Hospice Care NPs are authorized to serve as "attending physicians" in hospice and home health care. Authorized to re-certify patient eligibility for hospice care. Hospital Admitting Physical Examinations The physician counter signature requirement for hospital admitting physical examinations conducted by nurse practitioners has been eliminated.