A group of 12 organizations has submitted a letter to CMS requesting that it withdraw its recent guidance on the supervision required for hospital outpatient therapeutic services provided incident to a physician’s services. The guidance, provided in the 2009 Outpatient Prospective Payment System (“OPPS”) Final Rule published on November 18, 2008, made several “clarifications” to the supervision requirement for such services. See 73 Fed. Reg. 68702-4.
First, CMS “clarified” that it requires “direct supervision” for therapeutic services provided incident to a physician’s services in a hospital and in provider-based departments of the hospital (both on and off campus). In the 2001 OPPS Final Rule, CMS had required direct supervision for off-campus provider-based departments, but stated that direct supervision did not apply to services furnished in an on-campus outpatient hospital department. Second, CMS stated in the 2009 OPPS Final Rule that for provider-based departments, the physician providing the supervision must be present in the provider-based department. CMS has since incorporated this concept into the Medicare Benefit Policy Manual, Chapter 6, §20.5.1.
In the letter, the group of organizations has requested that CMS withdraw this guidance or, at least, give providers more time to make any necessary changes to become compliant. The group asserts that “there was a clear lack of effective and adequate notice about the CMS policy change, which as a result, affected the opportunity to comment on the proposal.” The group asserts that the “new policy places a considerable burden on hospitals, requiring them to engage more physicians for direct supervisory coverage without a clear clinical need.” The group also urges CMS to schedule a meeting to allow providers to offer feedback to CMS about these requirements. You can view the letter here.