CMS Releases Information on Physician Self-Referral Prohibition Exception Process for Physician-Owned Hospitals
The final CY 2012 Medicare Outpatient Prospective Payment System (OPPS) final rule implemented a statutory mandate that CMS develop an exceptions process related to the ACA’s prohibition on expanding an existing physician-owned hospital’s facility capacity. The rule provided that in order to be eligible for an exception, the physician-owned hospital must satisfy eligibility criteria to qualify as an “Applicable Hospital” or “High Medicaid Facility.” CMS has published additional guidance addressing the process for accessing data, along with sample computations for determining whether a hospital satisfies the respective criteria.
