This regulation requires skilled nursing and long-term care facilities to obtain radiology and other diagnostic services only upon a valid order from an authorized practitioner (physician, physician assistant, nurse practitioner, or clinical nurse specialist) and to promptly notify that practitioner of any results falling outside clinical reference ranges. Facilities must develop policies and procedures—in consultation with the medical director—defining notification timelines, urgency categories, and communication monitoring processes. Surveyors will review medical records to confirm ordered services were obtained timely and that out-of-range results were communicated without delay.
View official sourceF777 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.50(b)(2) The facility must— (i) Provide or obtain radiology and other diagnostic services only when ordered by a physician; physician assistant; nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws. (ii) Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of results that fall outside of clinical reference ranges in accordance with facility policies and procedures for notification of a practitioner or per the ordering physician’s orders. GUIDANCE §483.50(b)(2)(i)(ii) For purposes of this requirement “promptly” means that results shall be relayed, with little or no delay to the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist according to facility policies and procedures for notification and the medical orders. Facility policies and procedures should be developed in consultation with the medical director and follow current standards of practice. Such policies may include defining categories where follow-up is required, the urgency of reporting specific concerns, and a process for monitoring the effectiveness of communication to ensure that communication was received, and delegation by the ordering provider to a qualified on-call individual as appropriate. PROCEDURES When reviewing the resident’s medical record, surveyors would determine that radiology and other diagnostic services were provided only when ordered by a physician, physician assistant, nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws, and facility staff and the ordering provider(s) were promptly notified of the results. If results were not acted upon in a timely manner by the physician; physician assistant; nurse practitioner; clinical nurse specialist; or by facility staff as ordered, consider additional review for possible deficient practices under Medical Director, Nursing Services, Quality of Care or Quality of Life requirements. Do not cite any related or associated requirements before first conducting an investigation to determine compliance or non-compliance with the related or associated requirement. KEY ELEMENTS OF NON-COMPLIANCE To cite deficient practice at F777, the surveyor’s investigation will generally show that the facility failed to do any one or more of the following: • Provide or obtain radiology or other diagnostic services within the timeframe(s) specified in the medical order(s), or obtained or provided these services without an order by a physician; physician assistant; nurse practitioner or clinical nurse specialist in accordance with State and scope of practice laws; OR • Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of results according to facility policies and procedures for notification and the medical orders.