CMS clarifies: Non-doctors can admit Medicare patients

Guidance alleviates concerns related to hospital inpatient orders

CMS has issued guidance clarifying new requirements for Medicare inpatient admissions, explaining that the federal program will allow medical residents and other non-physician providers to admit patients despite unclear language in a recent rule.

The final rule for the fiscal year 2014 Inpatient Prospective Payment System (IPPS) instituted a time-based presumption period for medically necessary inpatient care. Under the rule, an admission is assumed to be appropriate for a Medicare Part A payment if a physician expects a beneficiary's treatment to require a two-night hospital stay and admits the patient under that assumption.

The change was made in response to concerns about the overuse of observation status by hospitals.

In a letter to CMS last month, the Association of American Medical Colleges (AAMC) voiced concern that the agency had inadvertently restricted the ability to admit patients to providers with "admitting privileges at the hospital," something that few residents have as they are not considered to be members of the hospital's medical staff.

However, a new five-page document for the agency clarifies that orders also may be documented by physician assistants, residents, or registered nurses, provided that the documentation is in compliance with state law, hospital policies, and medical staff bylaws and rules.

The agency says it plans to issue further guidance in the coming weeks (AHA News, 9/6).

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