Physician Acknowledgement Monitoring
As part of our Medicare Quality Improvement Organization contract, Qualis Health must ensure that each inpatient prospective payment system (PPS) hospital in Idaho and Washington is in compliance with the Medicare's physician acknowledgment requirement. We monitor physician acknowledgment statements on an annual basis.
When the hospital submits a claim, it must have on file a signed and dated acknowledgment from the attending physician. Existing acknowledgements signed by physicians on staff remain in effect as long as the physician has admitting privileges at the hospital.
Additionally, per CMS instructions, Qualis Health will perform random validation of the signed physician acknowledgment statements. If any of your physician acknowledgments are chosen as a random validation sample, we will contact your hospital for copies.
Follow-up Action
If the requested information is not received, the hospital will receive a 10-day reminder notice to send the necessary information so Qualis Health can complete the monitoring process.
If there is a pattern of deficiencies or non-compliance with the requests, an improvement plan will be requested and CMS will be notified concurrently. If the hospital fails to respond, or if a pattern of non-compliance is established, the issue will be referred to CMS Region X.
Contact us
For more information about our annual monitoring process, please contact:
Lisa W.
Send an email
206-364-9700
800-949-7536
About the acknowledgement form
Per 42 CFR §412.46, physicians who are granted admitting privileges at inpatient PPS hospitals are required to sign a statement acknowledging their understanding that Medicare's PPS is based in part on each patient's principal and secondary diagnoses and major procedures performed—as evidenced by the physician's entries in the patient's medical record.
Anyone who misrepresents, falsifies, or conceals essential information required for payment of federal funds may be subject to fines, imprisonment, or civil penalty under applicable federal laws.
Physicians must complete the acknowledgment statement 1) at or before the time admitting privileges are granted, or 2) prior to admitting their first patient.