SMQT Nursing and Physician Services 2 — Questions and Answers
Question 1: Under 42 CFR §483.30, what is the minimum requirement for physician visits to nursing facility residents following the initial visit?
- Every 30 days for the first 90 days, then every 60 days (Correct answer)
- Every 60 days for the first year, then annually
- Every 30 days indefinitely
- At least once per week during acute illness
Correct 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.
Question 2: 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?
- When the state does not authorize NPs to practice independently in SNFs (Correct answer)
- Whenever an NP signs any order in a SNF
- Only if the resident suffered harm from the order
- Only if the NP lacks a DEA number
Correct 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.
Question 3: Which of the following best describes a 'physician extender' in the context of nursing facility regulations?
- A nurse practitioner or physician assistant acting within their licensed scope (Correct answer)
- A registered nurse delegated to perform physical exams
- A consulting specialist called in for second opinions
- A telemedicine physician providing remote oversight
Correct 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.
Question 4: 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?
- Physician orders and timely authentication requirements (Correct answer)
- Medication administration error standards
- Nursing staffing adequacy requirements
- Resident rights and dignity standards
Correct 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.
Question 5: 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?
- 24-hour availability of physician services (Correct answer)
- Resident rights to choose their own physician
- Medical director qualifications requirement
- Minimum physician visit frequency
Correct 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.
Question 6: Which finding would most directly indicate a deficiency in nursing services under 42 CFR §483.35?
- No licensed nurse on duty during a night shift when a resident required medication administration (Correct answer)
- A resident preference to have family administer oral medications
- A delay in transcribing a non-urgent physician order
- An RN who supervised more than 10 aides simultaneously
Correct 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.
Question 7: 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?
- Cite a deficiency for failure to meet physician visit frequency requirements (Correct answer)
- No deficiency because the physician remained engaged via order signatures
- Request clarification from the physician before determining deficiency
- Cite only if the resident experienced an adverse outcome
Correct 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.
SMQT Nursing and Physician Services 2
Under 42 CFR §483.30, what is the minimum requirement for physician visits to nursing facility residents following the initial visit?