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My nurse practice act in Georgia is vague with regard to supervision/collaboration issues. There is no state where the law requires physicians to sign every one of a nurse practitioner's (NP's) charts. In Tennessee, a physician must sign 20% of an NP's charts every 30 days. In Arkansas, there is a requirement for physician cosignature of NP orders. Practice protocols or facility requirements must specify when NP's orders must be cosigned.
they do have an ABN signed by the beneficiary on file. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that he/she accepts responsibility for payment. The âGA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Fiscal Intermediary or Mac Part A, occurrence code 32 and the date of the ABN is required.