CMS’s recently proposed changes to physician supervision requirements for outpatient services should allow hospitals to achieve compliance with less financial strain, lawyers and compliance officers agree.

Proposed on July 1, the outpatient prospective payment system (OPPS) rule makes a number of provider-friendly changes to physician supervision requirements in all settings, from provider-based entities to hospital departments. Unless CMS makes modifications in the final rule, which is due by Nov. 1, these new provisions are scheduled to take effect on Jan. 1, 2010.

In a practical sense, these proposals ease most of the compliance and reimbursement burdens imposed by CMS’s recent restrictive policies on physician supervision of hospital outpatient services, which is required for all services provided “incident to” a physician’s professional services.

The most striking development is CMS’s intention, for the first time, to allow nonphysician practitioners (NPPs) — including nurse practitioners and physician assistants — to directly supervise all hospital outpatient therapeutic services that they can also personally perform according to their state scope of practice and hospital privileges, CMS said in a statement. As it now stands, only physicians can directly supervise outpatient services.

“This would be a very positive change from a Medicare perspective,” according to Wendy Trout, compliance officer at WellSpan Health in York, Pa. “That’s a good use of everyone’s time,” says Trout, who doesn’t advise hiring NPPs unless and until CMS finalizes this OPPS provision.

But CMS said that hospitals are not off the hook if they are already facing an investigation for billing in violation of the physician supervision rules. “We have not instructed contractors to delay initiation of enforcement actions or to discontinue pursuing pending enforcement actions regarding physician supervision of hospital outpatient services,” the proposed rule states. That will make hospitals nervous if they have ignored the latest CMS interpretations and failed to invest in physicians for supervision obligations to meet CMS requirements, with the hope that the agency would back off.

Full story