New Supervision Requirements for Hospital Outpatient Department Therapeutic Services
On November 18, 2008, as part of the 2009 OPPS Final Rule, CMS provided a "clarification" of its position regarding what level of physician supervision is required for the provision of on-campus outpatient therapeutic services.
Prior to November 2008, the provider community understood that CMS' position was that the direct supervision requirements for services provided incident to a physicin's services in an on-campus outpatient department was properly presumed to be met because staff physicians are always around in a hospital. CMS has indicated that it is concerned that hospitals have taken its prior expression of presumptive compliance to mean that no supervision was actually required at all.
While the OPPS Final Rule does not go further to state specifically that a physician must be physically present in an outpatient department of a hospital at all times, this "clarification" does seem to at least open the door for hospitals to be questioned about how, specifically, they meet the direct supervision requirements applicable in their various outpatient departments, where therapeutic services are provided.
In support of the sense that CMS is moving in this direction, it is also worth noting that in December of 2008, CMS revised language in its Medicare Benefit Policy Manual regarding provider-based services to indicate that "direct supervision" means that a physician must be present and on the premises of the provider-based department and immediately available to furnish assistance and direction.
Hospitals would, in light of these developments, be advised to evaluate all outpatient department and provider-based locations to evaluate the extent to which the services provided at those locations require direct physician supervision and then make sure they have a plan in place to meet that requirement.
