"So the walls have come down that were easy to identify when direct supervision was required in the department for off-campus PBCs," says Debbie Mackaman RHIA, CHCO, regulatory specialist for HCPro, Inc. "They have gone 180 degrees in the other direction from what they had 'clarified' in the CY2009 OPPS Final Rule and upheld in 2010."
Shah was pleasantly surprised by CMS' decision to back away from the boundary requirement, as this change seems to recognize that hospitals need more flexibility in how they deliver services.
However, Shah says that the onus is still very much on hospitals. She suggests that they proceed cautiously because if audited, they will need to be able to prove who was designated to be the supervisory physician, how the physician was immediately available, and that he or she could in fact be interrupted.
Delaying enforcement of supervision for CAHs
CMS will not evaluate or enforce the "direct supervision" requirement for therapeutic services furnished in 2010 and 2011 to outpatients in CAHs and rural hospitals. CMS initially suspended the requirement in March.
The CAHs made compelling enough arguments that CMS needed to look at this area more carefully. However, CMS continues to make the point that CAHs cannot operate just under their Conditions of Participation (CoP).
In addition to suspending the requirements for CAHs, CMS added small and rural hospitals to the mix because they have similar staffing problems, a decision that surprised Mackaman.
"Instead of including CAHs in the same policies for safety and quality as other hospitals, they have gone the other way and continued to suspend enforcement for CAHs in 2011 and added specific small and rural hospitals to this list," Mackaman says. "This is interesting because CMS was adamant that staffing requirements through the CoPs is for licensure and not for payment policies and that all Medicare beneficiaries should be able to expect a similar level of quality and safety in any hospital, regardless of size or payment methodology. It is good news for those hospitals but sends a mixed message."