Effective January 1, 2010, the 2010 Outpatient Prospective Payment System (“OPPS”) amends the prior hospital outpatient supervision requirements. Reaffirming that Medicare will only cover outpatient therapeutic services that are furnished in the hospital (“in the hospital” defined as the areas included in the main buildings of the hospital that are under financial or administrative control of the hospital, that operate or function as part of the hospital, and areas in which the hospital bills under the hospital’s CMS certification number), CMS also amends the supervision requirement to allow physicians and non-physician practitioners (i.e. clinical psychologists, physician assistants, nurse practitioners, ect.) (“Designated NPPs”) to supervise outpatient therapeutic incident to services.
Supervisory physicians or Designated NPPs are only permitted to supervise those therapeutic services that are within that physician’s or Designated NPP’s licensure, scope of knowledge, practice, skills, and hospital privileges. However, some cardiac services (i.e. cardiac rehabilitation services, intensive cardiac rehabilitation services, and pulmonary rehabilitation services) require physician supervision only. When supervising, the physician or Designated NPP must not be performing other procedures that s/he may not step away from to be immediately available on the same hospital campus to give assistance to the procedure s/he is supervising.
The OPPS also amends the outpatient diagnostic services supervision requirements, requiring that all hospital outpatient diagnostic services that are provided under arrangements in non-hospital facilities, require direct supervision.
For additional information, please contact Adrienne Dresevic, Esq. or Carey Kalmowitz, Esq. at (248) 996-8510 or visit The HLP website.