Administrative Memos

200402

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 06, 2004
SUBJECT: QIO Monitoring of Medicare Physician Acknowledgement Statements In Acute Long-Term Care Hospitals
IPRO CONTACTS:

Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, Extension 364

As you are aware, on August 30, 2002, the Centers for Medicare and Medicaid Services (CMS) published the "Prospective Payment System (PPS) for Long-Term Care Hospitals (LTCHs): Implementation and Fiscal Year 2003 Rates Final Rule". One of the provisions of this final rule requires QIOs to monitor Long-term Care Hospital compliance with Medicare's physician acknowledgement statement requirements effective with implementation of LTCH-PPS.

BACKGROUND

Regulations at 42 CFR 412.46 require hospitals paid under the Medicare Prospective Payment System (PPS) to obtain one signed acknowledgement statement from physicians who are being granted admitting privileges at a particular hospital. The physician must complete the acknowledgement at the time that he/she is granted admitting privileges at the hospital or before, or at the time the physician admits his/her first patient to the hospital.

When the hospital submits a claim, it must have on file a signed and dated acknowledgement from the attending physician that the physician has received the following notice as specified in 42 CFR 412.46(b):

Notice to Physicians: Medicare payment to hospitals is based in part on each patient's principal and secondary diagnoses and the major procedures performed on the patient, as attested to by the patient's attending physician by virtue of his or her signature in the medical record. Anyone who misrepresents, falsifies, or conceals essential information required for payment of Federal funds, may be subject to fine, imprisonment, or civil penalty under applicable Federal laws.

Existing acknowledgements signed by physicians already on staff remain in effect as long as the physician has admitting privileges at the hospital.

Hospitals must meet the conditions specified in 42 CFR 412, Subpart C to receive payment under the PPS for inpatient services furnished to Medicare beneficiaries. If a hospital fails to fully comply with these conditions with respect to one or more Medicare beneficiaries, the Centers for Medicare/Medicaid Services (CMS) may, as appropriate:

Withhold Medicare payment in full or in part to the hospital until the hospital provides adequate assurances of compliance; or
Terminate the hospital's provider agreement.

IPRO MONITORING RESPONSIBILITIES

The Federal regulation at 42 CFR 412.46 also require that QIOs monitor hospital compliance with the above requirements. Until now, the monitoring and reporting requirements have applied only to acute care general PPS hospitals in New York. They now apply to the new LTCH PPS program as well.

Therefore, your facility should ensure that it has obtained/is obtaining acknowledgements signed and dated by all physicians who admit Medicare patients as attending physicians and submit Medicare claims on behalf of your facility. With regards to future medical staff, IPRO strongly recommends that the Medicare acknowledgement statement be included as a permanent part of your hospital's standard credentialing package for newly appointed physicians.

As this is a new QIO activity, the monitoring process in this first year will include all LTCH physicians currently on staff as of the PPS implementation date (October 1, 2002) who admit Medicare patients as attending physicians. In subsequent years, monitoring will focus on new appointees only. To facilitate implementation of IPRO review, please refer to 7th SOW Physician Acknowledgement Statement Monitoring - Required Information and provide all information as requested to:

Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment
IPRO
1979 Marcus Avenue
Lake Success, NY 11042

Please refer to IPRO's procedure for requesting and monitoring this documentation.

Please feel free to contact Andrea Goldstein at extension 364, should you have any questions in regard to this memorandum.