Question of the Week


Thanks for the clarification a couple of weeks ago on the recent CMS Memorandum (S&C-12-17) regarding providers writing orders for outpatient hospital services.  As a follow-up question, are we required to check excluded provider status or query the National Practitioner Data Bank (“Data Bank”) for these ordering practitioners who do not hold clinical privileges at our hospital?


The CMS Memorandum does not specifically require a hospital to check excluded provider status or query the Data Bank for these practitioners.  However, a hospital is required to develop a policy that describes how it will handle these practitioners.

Even though not required by the CMS Memorandum, a hospital may want to check excluded provider status.  Many of the outpatient services these practitioners may order may be an item or service that is paid for in whole or in part by a federal health care program.  If the practitioner is excluded, the hospital would be subject to denial of payment and possible civil monetary penalties.

Since the ordering practitioners are not being granted clinical privileges, there is no requirement to query the Data Bank.  If a hospital decides that it does want a Data Bank report, it could require the practitioner to self-query.

Do you need more answers regarding the CMS Memorandum? Join Susan Lapenta and Phil Zarone of Horty, Springer & Mattern, and Nancy Lian of NAMSS for “Orders for Outpatient Tests and Procedures: ‘What We Really Meant Was ….’” as they discuss how hospitals can create – or adapt – a written medical staff policy to reflect CMS’ rules. This audio conference will be held on Friday, May 4 from 1:00 – 2:30 p.m. EDT.