Nursing and Physician Services Flashcards

Under 42 CFR §483.30, what is the minimum requirement for physician visits to nursing facility residents following the initial visit?

Answer: Every 30 days for the first 90 days, then every 60 days

CMS requires physicians to visit residents at least every 30 days for the first 90 days after admission, then at least every 60 days thereafter.

A surveyor finds that a resident's physician order was carried out by a nurse practitioner without any supervising physician oversight documented. Under which condition would this be a deficiency?

Answer: When the state does not authorize NPs to practice independently in SNFs

NP scope of practice in SNFs is governed by state law; if state law requires physician supervision and documentation is absent, a deficiency exists.

Which of the following best describes a 'physician extender' in the context of nursing facility regulations?

Answer: A nurse practitioner or physician assistant acting within their licensed scope

CMS uses the term 'physician extender' to refer to nurse practitioners and physician assistants who may perform certain physician functions when permitted by state law.

During a survey, you observe that telephone orders are routinely signed by the ordering physician more than 48 hours after being written. This is a deficiency under which regulatory area?

Answer: Physician orders and timely authentication requirements

CMS and most state regulations require verbal and telephone physician orders to be authenticated (countersigned) within 48 hours to ensure accuracy and accountability.

A long-term care facility has no physician available on-site and no formal written agreement with an on-call physician. A surveyor would cite this as a deficiency under which standard?

Answer: 24-hour availability of physician services

SNFs must ensure physician services are available 24 hours a day through an on-call arrangement to meet emergency needs of residents.

Which finding would most directly indicate a deficiency in nursing services under 42 CFR §483.35?

Answer: No licensed nurse on duty during a night shift when a resident required medication administration

Facilities must have a licensed nurse on duty 24 hours a day, 7 days a week; absence during a shift requiring medication administration is a direct violation.

A surveyor reviews a resident's medical record and notes the attending physician has not documented a required interval visit but has signed off on all orders. What is the appropriate survey action?

Answer: Cite a deficiency for failure to meet physician visit frequency requirements

Order signatures do not substitute for the required face-to-face physician visits; a missing documented visit is a citable deficiency regardless of other physician activity.