Northeast Health Care Quality Foundation
The QIO for Maine, New Hampshire and Vermont
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QIO TRANSMITTAL SERIES ISSUE: Physician Acknowledgement Requirement - Printable pages All hospitals are required to have on file a signed and dated acknowledgment from each physician, treating Medicare patients, that he/she received the following notice: "Notice to Physicians: Medicare payment to hospitals is based in part on each patient's principal and secondary diagnoses and the major procedures performed on the patient, as attested to by the patient's attending physician by virtue of his or her signature in the medical record. Anyone who misrepresents, falsifies, or conceals essential information required for payment of Federal funds, may be subject to fine, imprisonment, or civil penalty under applicable Federal laws." The acknowledgment must be completed by the physician at the time that the physician is granted admitting privileges at the hospital, or before or at the time the physician admits his or her first patient. Existing acknowledgments signed by physicians already on staff remain in effect as long as the physician has admitting privileges at the hospital. The Foundation is required to perform an annual review of the acknowledgment statements of physicians granted new hospital admitting privileges. To meet this requirement, the Foundation will ask for a list of physicians granted admitting privileges during the previous year. This list should include the following items: Physician name Physician UPIN Date admitting privileges granted Date acknowledgement signed Date of first claim submitted to the fiscal intermediary for that physician. This list must be signed by the administrator and sent to the Foundation. A copy of the signed acknowledgement for each physician on the list should be included. If no physicians were added to the staff, a signed statement indicating this must be submitted to the Foundation. If the Foundation’s review identifies any deficiencies, the Foundation will notify the hospital to provide an improvement plan to correct the deficiencies and will notify the fiscal intermediary for claim adjustments as appropriate. October 2003 Next Chapter: Quality Review Process
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