Question of the Week

Question: We were confused by a recent CMS Transmittal that seems to indicate that all providers writing orders for hospital outpatient services (i.e, rehabilitation and respiratory care) must be privileged by the hospital. This requirement would create huge headaches for us and our patients. Can you clarify CMS’s position on this issue?


This issue has been on the minds of many, ever since CMS published Transmittal 72 back in November.  It stated that certain hospital outpatient services could only be ordered by practitioners who had been granted clinical privileges to do so.

This set off a firestorm in the provider community.  Hospitals pointed out that Transmittal 72 created a huge problem for community physicians (i.e., those without hospital privileges) and for physicians whose patients travel out of town or, worse yet, out of state.

Fortunately, CMS issued a new memorandum on February 17, 2012 clarifying its position and updating its original guidance.  In the new memorandum, CMS makes it clear that outpatient services in hospitals may be ordered by a practitioner who is:

  • responsible for the care of the patient;
  • appropriately licensed;
  • acting within his/her scope of practice under state law; and
  • authorized by the medical staff to order the applicable outpatient services in accordance with hospital policy.

However, the practitioner is not required to hold medical staff privileges at the hospital under this new superseding guidance.

Did you notice the number of cases in this week’s HLE that involved employed physicians?  We did!  Join Linda Haddad, Henry Casale and Charlie Chulack to learn more – “Integrating Employed Physicians into the Health System of the Future,” April 12?14 at the Fairmont, Chicago.