HANDBOOK FOR

ADVANCED PRACTICE NURSES

CHAPTER N200
Policy and Procedures for Advanced
Practice Nurse Services
Illinois Department of Public Aid
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-200 (ii)
CHAPTER N-200
ADVANCED PRACTICE NURSE SERVICES
TABLE OF CONTENTS
FOREWORD
PURPOSE
N-200 BASIC PROVISIONS
N-201 PROVIDER PARTICIPATION
.1 Participation Requirements
.2 Participation Approval
.3 Participation Denial
.4 Provider File Maintenance
N-202 ADVANCED PRACTICE NURSE REIMBURSEMENT
.1 Charges
.2 Electronic Claims Submittal
.3 Claim Preparation and Submittal
.4 Payment
N-203 COVERED SERVICES
.1 Delivery Services
.2 Certified Family and Pediatric Nurse Practitioner (CFNP and CPNP)
.3 Certified Registered Nurse Anesthetist (CRNA)
N-204 NON-COVERED SERVICES
N-205 RECORD REQUIREMENTS
N-206 WRITTEN PRACTICE AGREEMENT GUIDELINES
.1 CFNP, CPNP and CNM Written Collaborative Agreement
.2 CRNA Written Practice Agreement
.3 APN Employed by a Group Practice
.4 APN Employed by a Hospital
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-200 (ii)
.5 Notification to the Department
.6 Prescriptive Authority
N-210 GENERAL LIMITATIONS AND CONSIDERATIONS ON COVERED
MEDICAL DIAGNOSTIC AND TREATMENT SERVICES
.1 Responsibilities for Services
.2 Duplicate Payments
N-222 MEDICAL DIAGNOSTIC AND TREATMENT SERVICE
.1 Laboratory Tests
N-240 MATERNAL AND CHILD HEALTH PROGRAM

Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-200 (iii)
FOREWORD
PURPOSE
This handbook has been prepared to provide information and guidance of advanced
practice nurses (APNs) who provide medical services and covered preventive
services to participants in the Departments Medical Programs. Coverage of APNs
for participation was enabled by Omnibus Budget Reconciliation Act of 1987
(OBRA) legislation for the purpose of improving access to primary medical care for
children and pregnant women. Included as APN providers are Certified Nurse
Midwives (CNM), Certified Family Nurse Practitioners (CFNP), Certified Pediatric
Nurse Practitioners (CPNP) and Certified Registered Nurse Anesthetists (CRNA).
The handbook is designed to provide specific policy guidelines applicable to APNs.
The handbook includes information on provider eligibility criteria, covered services,
reimbursement methodology, and billing instructions.
It is important that both the provider of service and the providers billing personnel
read all materials prior to initiating services to ensure a thorough understanding of
the Departments Medical Programs policy and billing procedures. Revisions in and
supplements to the handbook will be released from time to time as operating
experience and state or federal regulations require policy and procedure changes in
the Departments Medical Programs. The updates will be posted to the
Departments web site at http://www.state.il.us/dpa/


Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-200 (1)
CHAPTER N-200
ADVANCED PRACTICE NURSE HANDBOOK
N-200 BASIC PROVISIONS
For consideration to be given by the Department for direct payment to an advanced
practice nurse (APN), the services rendered must be provided by an APN enrolled
for participation in the Departments Medical Programs. The APN handbook
provides participation, enrollment, and payment information which is unique to
APNs.
This handbook is intended to be used in conjunction with both Chapter 100,
Handbook for Providers of Medical Services and Chapter A-200, Handbook for
Physicians. Chapter 100, Handbook for Providers of Medical Services, contains
general policy, procedures and appendices applicable to all participating providers.
Chapter A-200, Handbook for Physicians, includes policy guidelines and specific
billing information applicable to all providers of primary care services. The stated
policy and procedures apply to APNs except as noted herein.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-201 (1)
N-201 PROVIDER PARTICIPATION
N-201.1 PARTICIPATION REQUIREMENTS
It is required that each APN enroll with the Department in order to be eligible for
reimbursement for services by the Department. For the purpose of being eligible to
enroll as a provider, the Department defines advanced practice nurse as:
Certified Pediatric Nurse Practitioner (CPNP) and Certified Family Nurse
Practitioner (CFNP)
A CPNP or CFNP must be licensed as an advanced practice nurse who holds a
valid license in the state of practice and is legally authorized under state law or rule
to practice as a CPNP or CFNP pursuant to the Nursing and Advanced Practice
Nursing Act (225 ILCS 65) and its implementing regulations or comparable law in
the state of practice.
A CPNP and a CFNP must be currently certified as a pediatric nurse practitioner or
a family nurse practitioner by a certifying body recognized by the Illinois Department
of Professional Regulations (DPR) and maintain a written collaborative agreement
with a physician licensed to practice medicine in all its branches. Refer to Topic
N-206.1 for the policy regarding the written collaborative agreement.
Certified Nurse Midwife (CNM)
A CNM must be licensed as an advanced practice nurse who holds a valid license in
the state of practice and is legally authorized under state law or rule to practice as a
nurse midwife pursuant to the Nursing and Advanced Practice Nursing Act (225
ILCS 65) and its implementing regulations or comparable law in the state of practice.
The CNM must maintain a written collaborative agreement with a physician licensed
to practice medicine in all its branches. The CNM who attends deliveries must have
a written collaborative agreement with a physician who has hospital privileges.
Refer to Topic N-206.1 for the policy regarding the written collaborative agreement.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-201 (2)
Certified Registered Nurse Anesthetist (CRNA)
A CRNA must be licensed as an advanced practice nurse who holds a valid license
in the state of practice and is legally authorized under state law or rule to practice as
a nurse anesthetist pursuant to the Nursing and Advanced Practice Nursing Act
(225 ILCS 65) and its implementing regulations or comparable law in the state of
practice. CRNAs may enroll and provide services within the scope of their individual
license and established protocols. If services are provided in a licensed physicians
office, licensed dentists office, or a licensed podiatrists office, the CRNA must
maintain a written practice agreement. Refer to Topic N-206.2 for the policy
regarding the CRNA written agreement.
PROCEDURE: The provider must complete and submit:
Form DPA 2243 Provider Enrollment/Application
Form DPA 1413 Agreement for Participation
W9 Request for Taxpayer Identification Number
The following documentation must be provided with the application, if
appropriate.
CLIA Certificate (if the APN provides laboratory services)
Medicares assigned provider number if the APN is enrolled with Medicare
A copy of a valid APN license
Appropriate certificate - Refer to Topic N-201.1 (CFNP and CPNP only)
Written Collaborative Agreement - Refer to Topic N-206.1
Written Practice Agreement - Refer to Topic N-206.2
License to prescribe controlled substance, if appropriate. Refer to Topic N-206.6
for policy and procedures regarding prescriptive authority.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-201 (3)
Enrollment forms may be obtained from the Provider Participation Unit at
(217) 782-0538 or by sending a request to:
Illinois Department of Public Aid
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
E-mail requests for enrollment forms should be addressed to:
[email protected]
The written collaborative or practice agreements are defined in Topic N-206. The
agreements must be completed (printed in ink or typewritten) and signed and dated
in ink by the APN and the collaborative physician. For APNs that have an
agreement with more than one physician, a copy of all written collaborative or
practice agreements must be submitted with the initial application for enrollment. A
copy of the agreement(s) should also be retained by the APN.
The Departments enrollment forms must be completed (printed in ink or
typewritten), signed and dated in ink by the provider, and returned to the
Provider Participation Unit. The provider should retain a copy of the forms. The
date on the application will be the effective date of the enrollment unless the
provider requests a different enrollment date and it is approved by the Department.
N-201.2 PARTICIPATION APPROVAL
When participation is approved, the provider will receive a computer-generated
notification, the Provider Information Sheet. This sheet will list all the data being
carried in the Departments computer file including the categories of services the
APN is enrolled to provide and the effective date of enrollment. The APN should
review this information for accuracy immediately upon receipt. For an explanation of
the entries on the form, refer to A-200, Handbook for Physicians, Appendix A-7 and
A-7a.
If all information is correct, the APN should retain the Provider Information Sheet for
subsequent use in completing claims (billing statements) to insure that all identifying
information required is an exact match to that in the Departments file.
If information is incorrect, refer to Topic N-201.4
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-201 (4)
N-201.3 PARTICIPATION DENIAL
Written notification to a provider of denial of an application for participation will
include the reason for the denial.
Within ten calendar days after such notice, the provider may request a hearing. The
request must be in writing and must contain a brief statement of the basis upon
which the Departments action is being challenged. If such a request is not received
within ten calendar days, or is received but later withdrawn, the Departments
decision shall be a final and binding administrative determination. Department rules
concerning the basis for such denials are stated in 89 Ill. Adm. Code 140.14.
Department rules concerning administrative proceedings involving terminations or
suspensions of medical vendors are stated in 89 Ill. Adm. Code 104, Subpart C.
N-201.4 PROVIDER FILE MAINTENANCE
The information carried in Department files for participating providers must be
maintained on a current basis. The provider and the Department share
responsibility for keeping the file updated.
Provider Responsibility
The information contained on the Provider Information Sheet is that carried in
Departments computer files. Each time the provider receives a Provider
Information Sheet, the provider must review it carefully for accuracy. Inasmuch as
the Provider Information Sheet contains information to be used by the provider in
the preparation of claims, any inaccuracies found must be corrected and the
Department notified immediately.
Anytime a provider makes a change that causes information on the Provider
Information Sheet to become invalid, the provider must notify the Department.
When possible, notification should be made in advance of a change.
Procedure: The provider must line out the incorrect or changed data, enter the
correct data and sign the Provider Information Sheet on the line provided with an
original signature. Forward the corrected Provider Information Sheet to:
Illinois Department of Public Aid
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-201 (5)
Failure by a provider to properly notify the Department of corrections or changes
may cause an interruption in participation and payments.
Department Responsibility
Whenever there is any change in a provider's enrollment status or any changes
submitted by the provider, the Department will generate an updated Provider
Information Sheet reflecting the change and the effective date. The updated
Provider Information Sheet will be sent to the provider and to any payees listed if the
address is different from the provider.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-202 (1)
N-202 ADVANCED PRACTICE NURSE REIMBURSEMENT
N-202.1 CHARGES
Charges made to the Department must be the provider's usual and customary
charges to the general public for the services provided.
Providers may charge only for services they personally provide.
Covered services must be billed to the Department on form DPA 2360, Health
Insurance Claim Form, using the Current Procedural Terminology (CPT) book or
alpha numeric HCPCS codes.
N-202.2 ELECTRONIC CLAIMS SUBMITTAL
Any services which do not require attachments or accompanying documentation
may be billed electronically. Further information can be found in Chapter 100,
Handbook for Providers of Medical Services, Topic 112.3.
Providers should take special note of the requirement that Form 194-M-C, Billing
Certification Form, which the provider will receive with the remittance advice, must
be signed and retained by the provider for a period of three years from the date of
the voucher. Failure to do so may result in revocation of the providers right to bill
electronically, recovery of monies, or other adverse actions. Refer to Chapter 100,
Handbook for Providers of Medical Services, Topic 130.5 for further details.
Please note that the specifications for electronic claims billing are not the same as
those for paper claims. Please follow the instructions for the medium being used. If
a problem occurs with electronic billing, the provider should contact the Department
in the same manner as would be applicable to a paper claim. It may be necessary
for the provider to contact their software vendor if the Department determines that
the claim rejections are being caused by the submission of incorrect or invalid data.
N-202.3 CLAIM PREPARATION AND SUBMITTAL

Refer to Chapter 100, Handbook for Providers of Medical Services, Topic 112, for
general policy and procedures regarding claim submittal. For general information on
billing for Medicare covered services and submittal of claims for participants eligible
for Medicare Part B, refer to Chapter 100, Handbook for Providers of Medical
Services, Topics 112.5 and 120.1.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-202 (2)
For specific billing instructions, refer to A-200, Handbook for Physicians, Appendix
A-1.
N-202.4 PAYMENT
Payment made by the Department for allowable services or supplies provided to
patients is based on the individual providers usual and customary fees, within the
limitations established by the Department. The payment made is the lesser of the
providers charge or the maximum established by the Department. APNs will be
reimbursed at 70% of the physicians payment established by the Department, if
billing in the APNs name. If the billing is in the name of the collaborative physician,
the physician will be reimbursed at 100% of the maximum allowable fee. An APN
cannot enroll and receive enhanced rates as a Maternal and Child Health provider.
Refer to Topic N-240.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-203 (1)
N-203 COVERED SERVICES
A covered service is a service for which payment will be made by the Department.
Refer to A-200, Handbook for Physicians, Topic A-203.
Services provided by a CNM, CFNP, or a CPNP, pursuant to a current written
collaborative or practice agreement, will be covered in any setting to the extent that
the service would be covered if it were rendered by a physician.
N-203.1 DELIVERY SERVICES
The APN may be reimbursed for vaginal delivery of babies under one of the
following circumstances:
The provider of service is a CNM; or
The CFNP or CPNP is in an emergency situation (i.e., delivery is inevitable
and the physician is not available) and is the most qualified person available
to deliver the baby.
NOTE: Payment may be made for a vaginal delivery that the CNM performs in the
patients home. Refer to A-200, Handbook for Physicians, Topic A-290 for billing
instructions.
N-203.2 CERTIFIED FAMILY AND PEDIATRIC NURSE PRACTITIONER (CFNP and
CPNP)
Services provided by CFNPs and CPNPs, pursuant to a current written collaborative
agreement will be covered in any setting to the extent that the service would be
covered if it were rendered by a physician. Such services may include but are not
limited to exams, suturing, casting, diagnostic procedures and surgical assistant for
C-Sections.
NOTE: When an APN is functioning in the role of surgical assistant with the
collaborative physician, the APN must bill in their name and will be reimbursed at
70%. The collaborative physician cannot submit a claim for both the surgeon and
the surgical assistant using their own name and individual provider number.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-203 (2)
N-203.3 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
A licensed CRNA may provide anesthesia services pursuant to the order of a
licensed physician, licensed dentist, or licensed podiatrist in a licensed hospital, a
licensed ambulatory surgical treatment center, or the office of a licensed physician,
the office of a licensed dentist, or the office of a licensed podiatrist.
CRNAs are authorized to select, order, and administer drugs and apply the
appropriate medical devices in the provision of anesthesia services under the
anesthesia plan agreed to by the anesthesiologist or the physician in accordance
with hospital alternative policy or the medical staff consulting committee policies of a
licensed ambulatory surgical treatment center. In a physicians office, dentists
office, or podiatrists office, the anesthesiologist, operating physician, operating
dentist, or operating podiatrist shall agree to the anesthesia plan, in accordance with
the written practice agreement. Refer to Topic N-206.2 for an explanation
regarding the written practice agreement.

Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-204 (1)
N-204 NON-COVERED SERVICES
Services for which medical necessity is not clearly established are not covered
under the Departments Medical Programs. Refer to A-200, Handbook for
Physicians, Topic A-204, and Chapter 100, Handbook for Providers of Medical
Services, Topic 104 for a list of services for which payment will not be made.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA 205 (1)
N-205 RECORD REQUIREMENTS
Refer to Chapter 100, Handbook for Providers of Medical Services, Topic 110 for
record requirements applicable to all providers. Providers must maintain an office
record for each patient. In group practices, partnerships, and other shared
practices, one record must be kept with chronological entries by the individual
practitioner rendering services.
The record maintained by each provider must include the essential details of the
patients condition and of each service provided. Any services provided to a patient
by the provider outside the office must be documented in the medical record
maintained in the providers office. All entries must include the date and must be
legible and in English. Records which are unsuitable because of illegibility or
because they are written in a language other than English may result in sanctions if
an audit is conducted.
For patients residing in nursing facilities, the primary medical record indicating the
patients condition, treatment program, and services ordered and provided during
the period of institutionalization may be maintained as a part of the facility chart.
However, an abstract of the facility record including diagnosis, treatment program,
dates and times services were provided, must be maintained by the provider as an
office record to show continuity of care.
The Department and its professional advisors regard the preparation and
maintenance of adequate medical records as essential for the delivery of quality
medical care. In addition, providers should be aware that medical records are key
documents for post payment audits.
In the absence of proper and complete medical records, no payments will be
made and payments previously made will be recouped.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-206 (1)
N-206 WRITTEN PRACTICE AGREEMENT GUIDELINES
N-206.1 CFNP, CPNP AND CNM WRITTEN COLLABORATIVE AGREEMENT
The written collaborative agreement is the instrument which defines the relationship
between the collaborative physician and the CNM, CFNP, or the CPNP. The
collaborative physician must be currently licensed to practice medicine in all its
branches. The written collaborative agreement must be mutually developed by the
APN and the collaborative physician and must be approved by both. The written
collaborative agreement identifies the medical services to be provided within the
scope of each practitioners expertise, with medical direction and supervision where
appropriate, as defined by federal regulations and state law. The written
collaborative agreement is a key to what services the APN may provide and the
agreement should indicate at what point the APN should not proceed on their own.
Until that point, the APN has autonomy and the physician need not be present. The
services to be provided must be services which the physician generally provides his
or her patients in the normal course of the practice. The agreement must
encompass or include the following items at a minimum:
acknowledgment of statutory and clinical limits of the APNs authority to provide
medical care and the APNs accountability in relation to established goals and
needs of patients;
listing of medical procedures which the APN is delegated by the physician to
provide and listing of authorized procedures that require the physicians
presence as the procedures are being performed;
an explanation of how the physicians directions are to be communicated to the
APN;
an explanation of how the APN may assist in treating or responding to medical
emergencies;
an explanation of the criteria for consultation with the physician, as needed, and
required documentation in the patients record of such consultation;
a description, as needed, of the criteria and process for referrals of patients to a
specialist;
arrangements for a substitute physician when the collaborative physician is on
vacation or unavailable;
C a provision that the physician and the APN shall periodically assess the
implementation of the arrangement, including progress toward established
objectives, shall report the results of the assessment briefly in writing and shall
maintain this documentation with the agreement;
a provision that the APN shall identify himself or herself to patients as a nurse
practitioner or nurse midwife.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-206 (2)
NOTE: When services are provided that are not indicated in the written
collaborative agreement, the collaborative physicians countersignature is
required in the record.
N-206.2 CRNA WRITTEN PRACTICE AGREEMENT
CRNAs are required to maintain a written practice agreement if services are
provided in a physicians office, dentists office, or podiatrists office.
The agreement shall describe the working relationship of the CRNA and the
anesthesiologist, physician, dentist, or podiatrist and shall authorize the categories
of care, treatment, or procedures to be performed by the CRNA, in accordance with
225 ILCS 65/15-25.
N-206.3 APNs EMPLOYED BY A GROUP PRACTICE
When the APN is employed by a group practice, but works primarily with one
physician, it is only necessary to have a written collaborative agreement with the
collaborative physician. However, more than one physician may have a written
practice agreement with the same APN. Other physicians in a practice may serve
as a consulting physician when the collaborative physician is not available without
having a written practice agreement.
N-206.4 APNs EMPLOYED BY A HOSPITAL
When an APN is employed by a hospital, an agreement with a collaborative
physician is still required. Refer to Topic N-206.1. However, when an APN is
employed by the hospital, any services provided that fall under the hospitals
all-inclusive rate cannot be billed by the APN. The all-inclusive rate is a specified
rate which includes all services provided in an inpatient or outpatient setting for each
day a patient is treated. The all-inclusive rate is considered to cover all services
provided by salaried hospital personnel, all drugs administered and provided for
take-home use, all equipment and supplies used for diagnosis and treatment on the
hospital premises, and all x-ray, laboratory and therapy provided to the patient on
the same day. The hospital must bill using the hospitals fee-for-service provider
number for services provided that do not fall under the all-inclusive policy.
Examples of such services, that fall outside of the all inclusive rate, which would be
provided by an APN are antepartum and postpartum care.
N-206.5 NOTIFICATION TO THE DEPARTMENT
All services billed to the Department by the APN must be provided within the
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-206 (3)
provisions of the written practice or collaborative agreement. The agreements must
be reviewed at least annually and be updated as appropriate. A copy of the written
practice or collaborative agreement must be on file at each practice location. The
Department must be notified immediately if the agreement is dissolved because the
APNs enrollment must be terminated at that time.
N-206.6 PRESCRIPTIVE AUTHORITY
The CNM, CFNP, CPNP and the CRNA may be delegated limited prescriptive
authority by the collaborating physician as part of a written collaborative agreement.
This authority may, but is not required to, include prescription and dispensing of
legend drugs and legend controlled substances categorized as Schedule III, IV, or V
controlled substances, as defined in the Illinois Controlled Substance Act. To
prescribe Schedule III, IV, or V controlled substances, an APN must obtain a mid-
level practitioner controlled substance license. Medication orders must be reviewed
periodically by the collaborating physician.
The collaborating physician must file with the Department of Professional
Regulations notice of delegation of prescriptive authority and termination of such
delegation.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-210 (1)
N-210 GENERAL LIMITATIONS AND CONSIDERATIONS ON
COVERED MEDICAL DIAGNOSTIC AND TREATMENT
SERVICES
All limitations that apply to physician services also apply to services provided by
APNs. Program policies and procedures as stated in A-200, Handbook for
Physicians, applicable Department bulletins and publications, and the CPT should
be referenced for explanations of coverage.
N-210.1 RESPONSIBILITY FOR SERVICES
Determination of the medical necessity and appropriateness of service is the
responsibility of the physician as stated in the terms of the written collaborative
agreement, and is subject to review for conformity with accepted standards of
medical care and practice.
The APN and the collaborative physician will be held responsible for any
unnecessary, excessive, or otherwise inappropriate services rendered personally or
by another enrolled provider pursuant to either the APNs or physicians order(s).
As appropriate, the APN or the collaborative physician will be subject to any
corrective action, including recovery of payment made for inappropriate services.
Existence of the agreement does not relieve the APN or the physician of the
responsibility for the appropriateness of services and adherence to the
Departments Medical Programs policy and to federal and state statutes.
N-210.2 DUPLICATE PAYMENT
If the APN works in a hospital, home health agency, long term care facility, family
planning clinic, or other participating provider and bills the Department directly for
services provided at those sites during the period of the APNs employment
contract, it is the responsibility of the APN to ensure that the facility or the
collaborative physician is not also billing the Department for the same services. Any
duplicate payment will be recovered from the APN and appropriate referrals will be
made to the Office of the Inspector General.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-222 (1)
N-222 MEDICAL DIAGNOSTIC AND TREATMENT SERVICES
N-222.1 LABORATORY SERVICES
APNs providing laboratory services must comply with the Clinical Laboratory
Improvements Amendment (CLIA) Act.
A laboratory serving a physician or physicians in a group practice is considered a
physicians office laboratory. If laboratory services are included in the written
collaborative agreement, the APN may submit claims for laboratory services using
the CLIA certificate issued to the physicians office. Refer to the A-200, Handbook
for Physicians, Topic A-222.1 for further discussion on the Departments laboratory
policy and procedures.
Handbook for Advanced Practice Nurse Services Chapter N-200 - Policy and Procedures
January 2002 IDPA N-240 (1)
N-240 MATERNAL AND CHILD HEALTH PROGRAM
The Maternal and Child Health (MCH) Program is a primary health care program
coupled with case management services for pregnant women and children enrolled
in the Departments Medical Programs. The MCH program is designed to increase
provider participation through special incentives for the providers for certain services
provided to pregnant women and children through age 20.
An APN cannot enroll as a Maternal and Child Health provider. An APN who
performs MCH services, will be reimbursed at 70% of the lesser of the providers
charge or the maximum established by the Department, excluding the enhanced
physicians rate. Payment will be made at the enhanced rate, if the collaborative
physician who is enrolled in MCH delegates the services to the APN through the
written collaborative agreement and such services are submitted for reimbursement
under the name and provider number of that physician.