IPRO Annual Medicare Physician Acknowledgment Monitoring – Short Term Prospective Payment Systems (PPS) Hospitals (201101)

TO: IPRO Liaison
FROM: Theodore O. Will, FACHE /s/ Chief Executive Officer
DATE: January 3, 2011
SUBJECT: IPRO Annual Medicare Physician Acknowledgment Monitoring – Short Term Prospective Payment System (PPS) Hospitals
IPRO CONTACT: Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, (516) 209-5364

IPRO, as the Quality Improvement Organization (QIO) for New York, is required by the Centers for Medicare and Medicaid Services (CMS) to conduct monitoring of short term acute care Prospective Payment System (PPS) hospital compliance with securing physician acknowledgment statements for newly appointed physicians.  As you know, an acknowledgment statement must be completed by the physician at the time he/she is granted admitting privileges at the hospital, or before, or at the time the physician admits his or her first patient.  A copy of our monitoring process is included in Attachment I.

If you are an exempt psychiatric or non-acute care facility, this reporting requirement does not impact you at this time.

FOR ACTION:  To facilitate IPRO’s annual physician acknowledgment monitoring activities,please complete and return the required information as detailed in Attachment II (page 1,page 2), “IPRO 9th Scope of Work (SOW) Physician Acknowledgment Statement Monitoring” to the attention of:

by February 3, 2011.  Please note, in accordance with CMS QIO 9th SOW requirements, our physician acknowledgement monitoring activities for this year must be complete by July 1, 2011.

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 acknowledgment statement to this effect.

When a claim is submitted, the hospital must have on file a signed and dated acknowledgment from the attending physician that the physician has received the physician acknowledgment statement. The acknowledgment 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 acknowledgments 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 516-209-5364, should you have any questions in regard to this memorandum.