CMS published an announcement 7.20.09 describing regulatory changes that will impact standards for Medicare reimbursement starting 2010. The press release articulated the definition of “direct supervision” of an physician who is supervising nurse practitioners, clinical nurse specialists and/or certified nurse midwives as,”For services provided in the hospital, direct supervision means that the physician must be present in the hospital or on campus and immediately available to furnish assistance and direction throughout the performance of the procedure. For services furnished in an off-campus outpatient department, direct supervision means the physician must be present in the off-campus department and available to furnish assistance and direction throughout the performance of the procedure. In or out of the hospital, the physician need not be present in the room when the procedure is performed.” FEDERAL REGISTER July 20, 2009 Pgs. 35424 – 35425

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