FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 14, 2005
SUBJECT: MONITORING PHYSICIAN ACKNOWLEDGEMENT STATEMENTS - MEDICARE PROSPECTIVE PAYMENT SYSTEM (PPS) HOSPITALS
IPRO CONTACTS:
Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, Extension 364
Payment System (PPS) hospital compliance with securing physician acknowledgement statements. IPRO conducts this activity on an annual basis throughout the 7th Scope of Work.
IPRO is requesting from PPS Hospitals (including Long Term Care Hospitals) a listing of all physicians with new admitting privileges for the time period January 1, 2004 through December 31, 2004. This list should include the physician's name, UPIN Number, and the date admitting privileges were granted (see Attachment I). IPRO will randomly select a sample of up to 15 physicians (if there are five or less physicians, all will be selected) and request a copy of their signed Acknowledgement Statement as well as the date the physician's first claim was submitted to the Fiscal Intermediary (FI), when applicable.
A copy of IPRO's revised "7th Scope of Work Monitoring Plan for Physician Acknowledgement Statements" is included with this memorandum as Attachment II. This Plan has been revised to reflect the current Centers for Medicare and Medicaid Services (CMS) work instructions to be followed by all QIOs in conducting this activity. Changes made to our Plan as a result of the CMS instructions have been bolded. 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 have been provided to us. 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 I "IPRO 7th Scope of Work (SOW) Physician Acknowledgement Statement Monitoring" to the attention of Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment.
Please return all requested information by February 28th, 2005.
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. 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.