FROM: Theodore O. Will, Chief Executive Officer
DATE: Aug 07, 2003
SUBJECT: MONITORING PHYSICIAN ACKNOWLEDGEMENT STATEMENTS - MEDICARE PROSPECTIVE PAYMENT SYSTEM (PPS) HOSPITALS
IPRO CONTACTS:
Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, Extension 364
As you are aware, IPRO is required to monitor Prospective Payment System (PPS) hospital compliance with securing physician acknowledgement statements. IPRO will conduct this activity on an annual basis throughout the 7th Scope of Work.
A copy of IPRO's "7th Scope of Work Monitoring Plan for Physician Acknowledgement Statements" is included with this memorandum as Attachment I. Please note that IPRO continues to maintain, on file, the hospital-specific procedures for obtaining the acknowledgement statement from physicians (including the hospital's process for file maintenance) that were provided to us in the 6th Scope of Work. We do not require another copy of your plan for securing physician acknowledgement statements unless your process has changed. Therefore, please complete and return the required information as detailed in Attachment II, "IPRO 7th Scope of Work (SOW) Physician Acknowledgement Statement Monitoring" to the attention of Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment. In a small number of hospitals a copy of the plan may be required. If so, this will be reflected on the information form included in Attachment II.
Please return all requested information by September 5, 2003.
The Centers for Medicare/Medicaid Services (CMS) requires that all Quality Improvement Organizations (QIOs) monitor hospitals, at least annually, to ensure that they are appropriately obtaining acknowledgement statements from physicians with new admitting privileges as required by the regulations at 42 CFR 412.46 (Attachment III). The regulations require hospitals paid under 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 noted above 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, CMS may, as appropriate:
Please feel free to contact Andrea Goldstein at extension 364, should you have any questions in regard to this memorandum.