Medicare Compliance & Reimbursement

Medicare changes guidelines for history and physical examination, among others.

The Centers for Medicare & Medicaid Services (CMS) has finally updated its Medicare conditions of participation (CoPs) for hospitals in hopes that this will alleviate unnecessary regulatory burdens and give hospitals the flexibility they need to meet patients' needs.

In a Nov. 28 notice to providers, CMS issued the following changes:

History and Physical (H&P) examination. CMS will expand the timeframe for completion of the H&P and expand the number of permissible professional categories of individuals who may perform the H&P.

Authentication of verbal orders. This regulation requires that health care practitioners authenticate and record the date and time of all orders, including verbal orders. This reg comes with a temporary exception. "For a five-year period beginning with the date of publication of the final rule, the regulation requires that all orders, including verbal orders, must be dated, timed, and authenticated promptly by the prescribing practitioner or another practitioner responsible for the care of the patient, even if the order did not originate with him or her," CMS says.

This temporary revision to the authentication requirement should "reduce burden and provide flexibility for hospitals until the advancement of health information technology is sufficient to allow the prescribing practitioner to authenticate his or her own orders promptly and efficiently," the agency explains.

"In the absence of a State law specifying the timeframe for authentication of verbal orders, verbal orders need to be authenticated within 48 hours," CMS elaborates. "For the five-year period, verbal orders no longer need to be signed by the prescribing practitioner but can be authenticated by another practitioner responsible for the care of the patient."

Security of medications. This regulation requires that hospitals keep all drugs and biologicals in secure areas and locked when appropriate. CMS will allow hospitals to maintain flexibility in determining control of nonscheduled drugs and biologicals.

Postanesthesia evaluation. With this reg, the agency "permits the postanesthesia evaluation for inpatients to be completed and documented by any individual qualified to administer anesthesia instead of only the individual who administered the anesthesia."

The final rule appeared in the Nov. 27 Federal Register and will become effective Jan. 26.