Noridian - CRNA Practice & Chronic Pain Management

From: (a Minnesota Hospital Patient Financial Services Manager )
Sent: Thursday, March 24, 2011 11:04 AM

To: Bernice Hecker, Noridian Medical Director
Subject: CRNA Practice and Chronic Pain Management

Dr. Hecker:

We received Noridian’s Carrier Medical Directive regarding “CRNA Practice and Chronic Pain Management” last Friday 3/18. At (a hospital in Minnesota), (Provider number xx.xxx, NPI xxxxxxx) our physicians examine, order diagnostic tests and make the diagnosis that requires interventional injections for pain management. Our CRNAs, as part of the pain management team, perform those injections as per the physician’s orders.

By Minnesota Statute 148.284, the CRNAs are by definition and Certification, Advanced Practice Registered Nurses. They also have in place signed Advanced Practice Registered Nurse Prescriptive Agreements, Minnesota Statute 148.235 Subd. 2a, with physicians who also practice at this hospital. This is all in compliance with the Minnesota Board of Nursing and the Minnesota Board of Medical Practice. Section 140.4.3 from the Medicare Claims Processing Manual - Payment for Medical and Surgical Services Furnished by a CRNA (Rev 1, 10-01-03, B3 – 16003H), states “Payment can be for medical or surgical services furnished by non-medically directed CRNAs if they are allowed to furnish these services under State Law”.

It is our understanding that our current practice is appropriate, but would like you to confirm. Thank you for your time and attention to this matter.

Signed: (Minnesota Hospital Patient Financial Services Manager)





From: Bernice Hecker, Noridian Medical Director
Sent: Thursday, March 24, 2011 9:54 PM
To: (Minnesota hospital Patient Financial Services Manager)
Subject: RE: CRNA Practice and Chronic Pain Management

Absolutely. In Medicare (BBA, 1997), non-physician practitioners (NPPs) may provide the medical services within their state scope of practice and be reimbursed at 85% of the PFS (physician Fee Schedule.) Now, we do expect that any practitioner who performs any procedure on any patient independently assesses the patient and their suitability for the procedure as is consistent with decent patient care and CPT Manual instructions and payment. That is, a referral for a treatment from one MD to another or to a NPP does not necessarily mean that the procedure must be done. The practitioner providing the service must make that determination and is completely liable for the determination.

Excellent question. Thank you.

************************************************** ************************************

Information provided by:

Dan Simonson CRNA, MHPA e-mail: dsimonson@me.com