Are orders from an Advanced Registered Nurse Practitioner for care acceptable or do the orders have to be from a physician?

There are differences in the federal requirements for the certified home health agencies and the state law for state-licensed-only home health agencies. If your home health agency is Medicare and/or Medicaid certified, home health agency federal regulations require that orders for care come from a physician only. The federal regulations at do not accept orders from an Advanced Registered Nurse Practitioner.

If you are getting orders from an Advanced Registered Nurse Practitioner on behalf of the physician she/he works for, the physician needs to also sign them before billing for services. Here is the home health agency federal regulation, 42 Code of Federal Regulation 484.18(c) that requires physician orders: "(c) Standard: Conformance with physician orders. Drugs and treatments are administered by agency staff only as ordered by the physician with the exception of influenza and pneumococcal polysaccharide vaccines, which may be administered per agency policy developed in ... more.

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