Payment Matters: CMS Proposes Refinement of Outpatient Supervision Rules for Therapeutic Services


In its recently proposed Calendar Year 2012 Hospital Outpatient PPS (OPPS) payment rule [PDF], 76 Fed. Reg. 42170, 42277-42285 (July 18, 2011), which CMS recently put on its web page, CMS proposes refinements to its hospital outpatient physician supervision policies. First, CMS proposes to state clearly in the regulatory text at 42 C.F.R. § 410.27 that all hospital outpatient therapeutic services are subject to that section’s payment limitations, including the direct supervision requirement. Additionally, CMS clarifies that hospitals are not permitted to furnish therapeutic services or surgery to their patients under arrangements with ASCs. As justification for this position, CMS states that it does not make providerbased determinations for ASCs under 42 C.F.R. § 413.65(a)(1)(ii)(A) and that under 42 C.F.R. § 410.27(a)(1)(iii), therapeutic services must be furnished in provider-based space. As a result of these two provisions, ASCs may not be a provider-based department of a hospital pursuant to the regulations and their services, consequently, may not be covered as therapeutic hospital services under 42 C.F.R. § 410.27.

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