Administrative Memos

200601

FROM: Theodore O. Will, Chief Executive Officer
DATE: Mar 01, 2006
SUBJECT: ANNUAL (2006) PHYSICIAN ACKNOWLEDGEMENT MONITORING - REVISIONS TO THE QIO PROCESS FOR MONITORING PHYSICIAN ACKNOWLEDGEMENT STATEMENTS - MEDICARE SHORT TERM AND LONG TERM ACUTE PROSPECTIVE PAYMENT SYSTEM (PPS) HOSPITALS
IPRO CONTACTS:

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

As you are aware, IPRO, as the Quality Improvement Organization (QIO) for New York, is required to monitor Prospective Payment System (PPS) hospital compliance with securing physician acknowledgement statements. In June 2005, the Centers for Medicare & Medicaid Services (CMS) disseminated a revised process for QIO monitoring of physician acknowledgement statements. IPRO's revised process, included in Attachment I, incorporates the CMS changes (e.g., sample size requirements, date of first claim, etc.) and is being implemented by IPRO effective with our 2006 annual monitoring activities. As in the 7th SOW, IPRO will continue this activity on an annual basis throughout the 8th Scope of Work.

FOR ACTION: To facilitate IPRO's annual physician acknowledgement monitoring activities, please complete and return the required information as detailed in Attachment II, "IPRO 8th Scope of Work (SOW) Physician Acknowledgement Statement Monitoring" to the attention of Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment by MARCH 31st, 2006.

Background: Section 42 CFR 412.46 states that because payment under the Prospective Payment System (PPS) is based in part on each patient's principal and secondary diagnoses and major procedures performed, as evidenced by the physician's entries in the patient's medical record, physicians must complete an acknowledgement statement to this effect.

When a claim is submitted, the hospital must have on file a signed and dated acknowledgement from the attending physician that the physician has received the physician acknowledgement statement. The acknowledgement must be completed by the physician at the time that the physician is granted admitting privileges at the hospital, or before, or at the time the physician admits his or her first patient. 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 hospital services furnished to Medicare beneficiaries. As detailed in Attachment I, if a hospital fails to comply fully with these conditions with respect to one or more Medicare beneficiaries, 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.

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