Source of Truth for Physician Supervision Level for Facility/Technical Component
I am seeking clarification on how to determine the proper level of physician supervision that is required for given diagnostic services/procedures related to the reporting of the Facility/Technical component. It has always been my understanding that for Outpt. Diagnostic Services, even on the hospital side), one should use the MPFS Physician Supervision Level Indicator value with its corresponding definition. Recently it was conveyed to me that the MPFS only applied to Professional billing and not Facility billing. I am trying to determine if this is correct. An example would be an OP radiology test that has both TC and PC components. The TC component has a Supervision Level of 3 (personal) in the MPFS. Based on that, it is my understanding that the physician(radiologist) would have to be physically present with the patient during the test in order for the hospital to bill the service. I am now being told the physician only has to provide direct supervision and just be immediately available. Does the Physician Supervision Indicator apply to hospital charge reporting?
Sign In to comment.
I'm trying to learn this stuff and this is cool!
"We have further defined the requirements for diagnostic services furnished to hospital outpatients, including requirements for physician supervision of diagnostic services, in §§ 410.28 and 410.32 of our regulations. Section 410.28(e) states that Medicare Part B makes payment for diagnostic services furnished at provider-based departments (PBDs) of hospitals ‘‘only when the diagnostic services are furnished under the appropriate level of physician supervision specified by CMS in accordance with the definitions in §§ 410.32(b)(3)(i), (b)(3)(ii), and (b)(3)(iii).’’ In addition, in the April 2000 OPPS final rule with comment period (65 FR 18526), we stated that our model for the requirement was the requirement for physician supervision of diagnostic tests payable under the MPFS that was set forth in the CY 1998 MPFS final rule (62 FR 59048). In 2000, we also explained with respect to the supervision requirements for individual diagnostic tests that we intended to instruct hospitals and fiscal intermediaries to use the MPFS as a guide pending issuance of updated requirements. For diagnostic services not listed in the MPFS, we stated that fiscal intermediaries, in consultation with their medical directors, would define appropriate supervision levels in order to determine whether claims for these services are reasonable and necessary. Since 2000, we have continued to follow the supervision requirements for individual diagnostic tests as listed in the MPFS Relative Value File. "The file is updated quarterly and is available on the CMS Web site at: n on DSK2BSOYB1PROD with RULES2 60576 Federal Register / Vol. 74, No. 223 / Friday, November 20, 2009 / Rules and Regulations http://www.cms.hhs.gov/PhysicianFeeSched/.