CRNNS recognizes the registered nurse (RN) as an important part of a collaborative team in a family practice setting.
According to the RN Act (2006), it is within the scope of practice of the RN to independently assess, plan and coordinate care, provide guidance and counseling, monitor and adjust the plan of care, make referrals to other health providers, community resources and evaluate clients’ response to treatment. It is important that RNs are aware of their scope of practice and MSI billing practices which can impact how an RN can independently practice in a family practice setting.
All insured services that are claimed for payment by a physician must reflect services they personally provide to the client. The physician can also claim for encounters conducted partially by the nurse as long as the physician has interacted directly with the client; for example, by assessing the client themselves. The physician’s participation must be documented in the client’s chart note (Nova Scotia Medical Services Insurance, 2014). As a result, indirect physician-to-client interaction would not be considered sufficient interaction for MSI billing purposes. For example, “saying a brief hello would not, for example, meet…visit requirements” (Church, 2013, p. 21). Equally, a signature on the client’s record or a chart review after the client’s visit has concluded is not defined as direct interaction between the client and physician (Nova Scotia Medical Services Insurance, 2014).
A Physician may bill MSI when a nurse independently performs the following procedures provided that the physician is on the premises when the service is provided:
- Pap examination
- Influenza vaccine
- Other injections (e.g., B12, Enbrel) (Nova Scotia Medical Services Insurance, 2014).
The College is supportive of family practice nurses optimizing their scope of practice but recognizes the importance of being clear about the current MSI billing processes. If you have any questions about this or other professional practice issues please contact us at firstname.lastname@example.org.
- Church, R. (2013). Billing for services of other health-care workers prompts questions. doctorsNS, 12(8), 21. Retrieved from http://www.doctorsns.com/site/media/3DIssue/doctorsns-feb-2013/index.html
- Nova Scotia Medical Services Insurance. (2014). Physician Manual. Retrieved from http://www.medavie.bluecross.ca/static/MSI/PhysicianManual.pdf