|
Return to Provider-Based Regulations Information
Obligations of Hospital Outpatient Departments and
Hospital-Based
Entities After January 10, 2001
Updated with August 12, 2005 amendments
Note these requirements are effective for a hospital at the start
of its first cost reporting period after January 10, 2001
The provider-based regulations
include the following obligations for hospital provider-based outpatient departments and,
in some instances, hospital-based entities. The regulations do not define
"hospital-based entities" and until we get clarification from CMS as to the
difference, if any, between a hospital outpatient department and a "hospital-based
entity" we assume it means any provider-based facility for which a hospital is the
main provider.
| Obligations of hospital outpatient departments
and hospital-based entities |
Application |
|
Link to EMTALA requirements. Note
that these new requirements are effective November 10, 2003. |
Hospital outpatient
departments on and off-campus |
| Physician services
must be billed with the correct site-of-service indicator so
that reductions to physician and practitioner payment amounts
can be applied |
All with
hospital-based status except RHCs |
| Hospital outpatient departments must comply with all the terms of the hospital's provider agreement. |
Hospital outpatient departments on and off-campus |
| Physicians are obligated to comply with the non-discrimination provisions of:
1) Title VI of the Civil Rights Act of 1964, as implemented by
45 CFR part 80, which provides that no person in the United
States shall, on the ground of race, color, or national origin,
be excluded from participation in, be denied the benefits of, or
be subject to discrimination under, any program or activity
receiving Federal financial assistance; 2)
Section 504 of the Rehabilitation Act of 1973, as implemented by
45 CFR part 84, which provides that no qualified handicapped
person shall, on the basis of handicap, be excluded from
participation in, be denied the benefits of, or otherwise be
subject to discrimination under any program or activity
receiving Federal financial assistance; 3) the Age
Discrimination Act of 1975, as implemented by 45 CFR part 90,
which is designed to prohibit discrimination on the basis of age
in programs or activities receiving Federal financial
assistance; and 4) other pertinent requirements of the
Office of Civil Rights of HHS |
All with hospital-based status |
| Hospitals must treat
all Medicare patients, for billing purposes, as hospital
outpatients; the hospital must not treat some Medicare patients
as hospital outpatients and others as physician office patients |
Hospital outpatient departments on and off-campus, except RHC's |
| For patients admitted
to the hospital the 72 hour window applies to PPS hospitals and
the 24 hour rule for PPS-exempt hospitals or units |
Patients admitted to the hospital from hospital-based entities |
| When a Medicare
beneficiary is treated in a hospital outpatient department that is not located on the main provider's campus,
the treatment is not required to be provided by the antidumping rules in Sec. 489.24 of this chapter,
and the beneficiary will incur a coinsurance liability for an outpatient visit to the hospital as well as for
the physician service, the hospital must provide written notice to the beneficiary, before the delivery of
services, of the amount of the beneficiary's potential financial liability; or, if the exact type and extent of care
needed is not known, an explanation that the beneficiary will incur a coinsurance liability
to the hospital that he or she would not incur if the facility were not provider-based,
an estimate based on typical or average charges for visits to the facility, and a
statement that the patient's actual liability will depend upon the actual services furnished by the hospital.
The notice must be one that the beneficiary can read and understand.
If the beneficiary is unconscious, under great duress, or for any other reason unable to read a written notice and understand and act on his or her own rights, the notice must be provided, before the delivery of services, to the beneficiary's authorized representative.
In cases where a hospital outpatient department provides examination or treatment that is required to be provided by the antidumping rules of Sec. 489.24 of this chapter, notice, as described in this paragraph (g)(7), must be given as soon as possible after the existence of an emergency has been ruled out or the emergency condition has been stabilized.
|
Hospital outpatient
departments off-campus |
| Must meet applicable
Medicare Conditions of Participation for hospitals |
Hospital outpatient departments on and off-campus |
|
