CMS SOM App. PP, Tag F777

(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 Do not cite any related or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.