The Centers for Medicare & Medicaid Services last week issued guidelines addressing concerns with new requirements for admission and medical review criteria for hospital inpatient services under Medicare Part A, according to AHA News Now.
In the guidelines, CMS clarifies that individuals who are not physicians--such as physician assistants, residents or registered nurses--can write the order to admit a patient as long as the documentation of the order complies with state law, hospital policies and medical staff bylaws.
"At some hospitals, practitioners who lack the authority to admit inpatients under either State laws or hospital by‐laws may nonetheless frequently write the sets of admitting orders that define the initial inpatient care of the patient," CMS explains in the guidelines addressing hospital inpatient admission order requirements.
In such cases, the order must identify the qualified "ordering practitioner" and have the ordering practioner or another practitioner qualified to admit inpatients authenticate (sign, date and time) the order prior to discharge, CMS notes.
"The order to admit as an inpatient ("practitioner order") is a critical element of the physician certification, and is therefore also required for hospital inpatient coverage and payment under Part A," CMS states in the guidelines.
The inpatient admission and medical review criteria clarifications should ease the concerns of teaching hospitals, which warned the finalized Hospital Inpatient Prospective Payment System (IPPS) unintentionally prevents medical residents from admitting patients.
As the Association of American Medical Colleges noted late last month, the wording of the IPPS final rule requires that a practitioner "who has admitting privileges at the hospital"--something few residents have--write the order to admit a patient, FierceHealthcare previously reported.