CMS Substantially Revises Physician Supervision Requirements

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In the 2011 outpatient prospective payment system (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) has substantially revised its physician supervision policy by:

·         Eliminating the requirement that a supervising physician must be “on the same campus" or “in the off-campus provider-based department of the hospital"

·         Identifying a limited set of “non-surgical, extended duration therapeutic services" for which direct supervision is required only for initiation of the service, followed by a general supervision requirement for the remainder of such service

·         Announcing its intent to establish an independent review process for evaluating the appropriate level of physician supervision for specific therapeutic services in the calendar year 2012 OPPS rulemaking cycle

Over the last couple years, CMS has clarified and refined the rules relating to physician supervision of hospital outpatient services.  CMS currently requires direct supervision for most outpatient therapeutic services in hospital outpatient departments.  Historically, direct physician supervision was assumed in on-campus settings.  However, in the preamble of the 2009 OPPS rule, CMS “clarified" that assumed supervision did not mean that no supervision was required, and that hospitals had to ensure supervising physician presence and immediate availability to meet the direct-supervision requirement that applies to most outpatient therapeutic services and to many diagnostic services.

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