Retroactive Rule Change by CMS Eases Family Physicians' Workload

PAs Can Perform Skilled Nursing Facility Certifications, Recertification

January 31, 2012 06:15 pm News Staff

Family physicians who care for Medicare patients admitted to skilled nursing facilities should know that CMS has made a change retroactive to Jan. 1, 2011, that adds physician assistants (PAs) to the list of health care professionals allowed to perform skilled nursing facility "level of care" certifications and recertifications.

According to a Jan. 13 issue of MLN Matters(, initial certification and periodic recertification of a patient's need for skilled nursing facility level of care are requirements for Medicare coverage of skilled nursing home facility services under Medicare Part A.

Note that the implementation date for this change is February 13, 2012 -- more than one year after CMS announced the change to comply with the Patient Protection and Affordable Care Act.

Physicians may have claims that were denied because certification or recertification was completed by a PA on or after Jan. 1, 2011, and before the 2012 implementation date. CMS has directed contractors to reopen and reprocess claims that were mistakenly denied, but only if physicians bring those claims to their contractors' attention.

Contractors will not search a physician's claims history to find claims that were denied.

According to Cynthia Hughes, C.P.C., an AAFP coding and compliance specialist, it's not unusual for CMS to announce rule changes when the agency issues a change request to Medicare contractors and then allow many months to pass before implementation, thereby giving Medicare contractors ample time to put the change into place.

Family physicians might find it helpful to know that MLN Matters articles -- which are produced by CMS' Medicare Learning Network exclusively for physicians and other health care professionals -- are archived( and readily available dating back to June 2007.