Hospital Outpatient Direct Supervision Requirement Eliminated

This year, the Centers for Medicare and Medicaid Services (CMS) will implement a lower physician supervision requirement for hospital outpatient therapeutic services. CMS has required direct supervision of services such as, chemotherapy and radiation therapy for the past decade.

The change was finalized in November 2019, making general supervision the minimum required level of supervision for hospitals and critical access hospitals starting Jan. 1, 2020. The prior minimum requirement, direct supervision, called for the immediate availability of a physician when outpatient therapeutic services are provided to Medicare beneficiaries.

General supervision does not require the physician’s presence during services, but they must be under the physician’s direction and control.  According to the agency, “this change does not preclude a hospital from requiring a higher level of supervision for certain services, as it determines appropriate.”

Hospitals must budget how services are supervised and recent settlements have amounted to millions due to hospitals violating CMS’ direct supervision rule. Generally, violations of supervision rules can lead to reimbursement denials and whistleblower lawsuits. Cases involving the Department of Justice in 2017 and 2015 amounted to more than $12 million in settlements after hospitals provided patients with radiation oncology services without supervision by radiation oncologists.

Although CMS’ new rule reduces the level of default supervision, the agency can increase the supervision level of individual hospital outpatient services to higher levels.

The rule ultimately allows hospitals to decide appropriate supervision levels at their discretion, with the minimum requirement being general. Hospitals may choose to implement higher levels of supervision for more complicated services.

CMS believes the elimination of the direct supervision rule will make the delivery of these outpatient services more efficient and easier, without impacting the quality of care and healthcare access.

For more on the new rule, check out this Health Leader’s Media article.

Also, visit CMS for more information on the rule.

Take a look at RevCycle Intelligence for more commentary.