Industry News

CMS Issues Article on Physician-owned Hospital Reporting Requirements for the Whole Hospital or Rural Provider Exception.

Jennifer Kirchner | September 2013

The Centers for Medicare & Medicaid Services (CMS) issued a Medicare Learning Network (MLN) Matters article regarding reporting requirements for hospitals with physician owners or investors (physician-owned hospitals) that seek to avail themselves of the whole hospitals or rural provider exception to the self-referral law. The article addresses reporting requirements mandated by Section 6001 of the Patient Protection and Affordable Care Act (PPACA). Physician-owned hospitals should note that the PPACA bars any hospital with new physician ownership occurring after December 31, 2010 from qualifying for the whole hospital exception, and hospitals with physician ownership as of March 23, 2010 are grandfathered for the same percentage of physician ownership they had on that day.

Physician-owned hospitals seeking to quality for either exception must submit an annual report to CMS containing ownership and investment information by December 1, 2013. The reporting requirement can be fulfilled by following the instructions set forth in the Medicare Enrollment Application Form CMS-855A (CMS-855A). Physician-owned hospitals that submitted information through this process on or after December 1, 2012 will be considered to have met the December 1, 2013 deadline. To continue to meet the reporting requirements, physician-owned hospitals seeking either exception must update their information or verify that the relevant ownership and investment information in the Medicare Provider Enrollment, Chain, and Ownership System is correct on an annual basis. Hospitals seeking to qualify for either exception should note that information submitted by this process may be published on the CMS website pursuant to the Social Security Act.

The MLN Matters article regarding physician-owned hospitals reporting requirements is available at:

The Centers for Medicare & Medicaid Services. “Additional Reporting Requirements Concerning Physician Ownership and Investment in Hospitals.” MLN Matters Article: SE1332. 9 Sept. 2013.

About the Author

Jennifer Kirchner is a licensed attorney in Illinois and Wisconsin. Ms. Kirchner has expertise in assessing provider compliance with the Anti-Kickback Statute, Stark Law, the False Claims Act, HIPAA Privacy and Security Rules and clinical research laws and regulations.