Can NPs admit?

Depends on your hospital's credentialling. I'm credentialled at six hospitals. At one, I can write "admit to Dr Joe Blow" and sign "traumarus, APN." At another hospital, ALL my orders must be signed "traumarus, APN/Joe Blow, MD".

So...at least for me, its not a billing issue but rather a credentialling issue.

I cover for a busy clinic practice every 5th weekend or so. This is part of my "on call" schedule with my employer. Anyway, I have been sent to the ER to evaluate pts and have gotten calls re: patients in the ER. I have given admitting orders for many, many patients. My billing person now thinks that NPs cannot not admit to the hospital and asked the medical credentialling person if I have admiting credentials. She was told that I do not. My boss seems to think the billing specialist is mistaken. I am unsure if this is a hospital policy or a CMS rule. My question is simply, Can an NP admit a patient to the hospital or would he/she have to write the order as a "verbal" order from the dr? Thanks

Medicare specifically lists NPs, CNS, PAs and Physicians as the four providers that can determine whether a patient meets inpatient or observation status. They are also the four types of providers that can bill for the initial inpatient evaluation. So this is not a CMS issue. All inpatients must have an assigned physician per CMS guidelines.

Individual hospitals can restrict admission privileges to MDs only, but this is rare in my experience.

They may be confusing the shared billing rules. Shared billing for initial inpatient evaluation or consults is no longer allowed and must be billed under the provider that does all the work.

Admissions is one of the check boxes on our priviliging sheets. However, the hospital will only give you privileges if you are on an admitting service. For example the NPs in Radiology do not have admitting priveleges. On the other hand since I admit 10-15 patients per week its a good thing that I do.

Check with your hospital medical staff and see if you have priveleges. If you don't see what you need to do to obtain them.

David Carpenter, PA-C

Agree with above, you need to be credentialed by the hospital's Credentialing amd Priviledging Committee or Board to perform tasks such as writing admitting orders. In some cases, how you write your orders is very much dependent on stipulations set forth by specific hospitals. JCAHO has actually been checking in on credentialing documents during site visits to hospitals. It is not wise for hospitals to allow midlevels to start working on their own without having gone through credentialing.

As far as billing, Medicare allows a nurse practitioner to write admitting orders if performed in collaboration with a physician. Even in states where the Nurse Practice Act allows for fully-independent practice for nurse practitioners, a collaborating physician on record is still required for a nurse practitioner to directly bill. As David stated, CMS requires that all patients admitted to a hospital be under the care of a physician.

Here is a FAQ from the Amer. Coll. of NP's website: http://www.acnpweb.org/i4a/pages/Index.cfm?pageID=3438