Does Medicare allow nurse practitioners (NPs) to lead meetings?

Medicare Reimbursement for Nurse Practitioner-Led Meetings

Yes, Medicare allows and reimburses nurse practitioners (NPs) to lead and facilitate patient care meetings, including family meetings, interdisciplinary team meetings, and palliative care consultations, as NPs can bill for Medicare professional time and services comparable to physicians since receiving their Medicare billing identifier in 2008 1.

NP Authority in Meeting Facilitation

NPs are explicitly recognized as qualified professionals to lead formal family meetings and care coordination discussions. The American Society of Clinical Oncology guidelines specifically recommend that "a medical professional" should be designated to facilitate family meetings, with NPs included in this category alongside physicians 1. These meetings can occur in both hospital and outpatient settings at important junctures in care 1.

Specific Meeting Types NPs Can Lead

Family Meetings and Care Conferences

• NPs can independently facilitate formal family meetings to discuss goals of care, treatment planning, and end-of-life decisions 1
• These meetings should include patients, designated surrogates, and desired medical professionals, with the NP serving as the facilitator 1
• NPs should review medical records beforehand, introduce attendees, explore family agendas, and establish follow-up plans 1

Interdisciplinary Team Meetings

• NPs participate in and can lead daily interprofessional rounds and weekly team meetings for care coordination 1
• In palliative care teams, NPs work alongside physicians, social workers, and chaplains in coordinated meetings 1
• The Brain Attack Coalition specifically recommends that primary stroke centers have at least one advanced practice nurse to "implement and coordinate program activities," including leading team meetings 1

Patient Education and Care Management Sessions

• NPs can lead specialized care management programs where they design interventions with patient input and lead shared decision-making efforts 1
• NPs may conduct structured educational sessions, including telephone-based formats and group-shared medical appointments 1
• In the ENABLE II trial, NPs led four structured educational sessions covering problem-solving, communication, symptom management, and advance care planning 1

Billing and Reimbursement Framework

Medicare reimburses palliative care and care coordination services provided by NPs as a medical specialty comparable to other physician specialties 1. Key billing considerations include:

• NPs can bill directly for professional time and services since 2008 when hospice and palliative medicine received a Medicare billing identifier 1
• Medicare typically pays NPs 85% of the physician fee schedule for the same service when billing directly 2
• NPs cannot bill for services provided by other interdisciplinary team members (chaplains, social workers) who lack independent billing privileges 1

Important Regulatory Limitations

While NPs can lead meetings and bill for their services, specific Medicare restrictions exist for certain certification functions:

• NPs cannot certify or recertify terminal illness for hospice patients, though they can complete face-to-face encounters to validate hospice eligibility 3, 4
• NPs cannot certify or recertify Medicare home health services, despite providing comprehensive home-based primary care 4
• These regulatory barriers exist despite NPs being allowed to function as a patient's hospice attending physician since 2003 3

Clinical Context and Team Dynamics

The role of meeting leadership should be determined by patient needs and clinical expertise rather than rigid hierarchy 5. In dynamic clinical care teams:

• NPs may lead specific care elements when their specialized training (e.g., diabetes education, symptom management) makes them the most appropriate clinician 1, 5
• When NPs lead patient engagement and self-management efforts, the physician typically maintains overall clinical responsibility for complex medical conditions 1
• Effective collaboration requires regular communication through rounds, meetings, electronic health records, and other channels 5

State Practice Variations

State scope-of-practice laws may affect NP autonomy in leading meetings, though Medicare reimbursement remains available regardless of state restrictions 2. States with more restrictive NP practice laws show different patterns of care delivery, but this does not eliminate Medicare's recognition of NP services 2.