Corporate Compliance

Note from Hugh

Medicare Insider, June 24, 2008

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As noted below, last week CMS finally revised the manual instructions on coverage of “incident to” services furnished by a hospital. Many hospitals will be relieved to see that CMS has deleted the requirement that direct supervision be furnished by a physician “who is treating the patient.” The revised “incident to” supervision is now as follows:
The physician supervision requirement is generally assumed to be met where the services are performed on hospital premises. The hospital medical staff that supervises the services need not be in the same department as the ordering physician. However, if the services are furnished at a department of the hospital which has provider-based status in relation to the hospital under 42 CFR 413.65 of the Code of Federal Regulations, the services must be rendered under the direct supervision of a physician. “Direct supervision” means the physician must be present and on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.
            Medicare Benefit Policy Manual, Chapter 6 § 20.5.1 (Effective 7/1/08)
 
Unfortunately, this revision does nothing to clarify the question of whether the direct supervision requirement still applies if the services are furnished at a department of the hospital which has provider-based status and is located on the hospital premises. Also, the term “hospital premises” is undefined. CMS could easily resolve this remaining confusion by:
  1. Replacing the term “hospital premises” with the term “hospital campus.” The term “campus” is defined in the provider-based regulations (42 CFR 413.65) as “the physical area immediately adjacent to the provider’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the CMS regional office, to be part of the provider’s campus.”
  2. Explicating stating that the direct supervision requirement only applies to “off campus” provider-based facilities.

I emailed Heather Hostetler at CMS and suggested that CMS further revise the paragraph in question to read as follows:

The physician supervision requirement is generally assumed to be met where the services are performed on the hospital campuspremises. The hospital medical staff that supervises the services need not be in the same department as the ordering physician. However, if the services are furnished at an off campus department of the hospital which has provider-based status in relation to the hospital under 42 CFR 413.65 of the Code of Federal Regulations, the services must be rendered under the direct supervision of a physician. “Direct supervision” means the physician must be present and on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.
If I receive a response, I will update everyone in a future issue of the Medicare Weekly Update.


 



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