Provider Based Attestation and Self Reporting
Should an attestation statement be submitted
Effective October 1, 2002, the mandatory requirement for provider-based determinations under §413.65(b) has been replaced with a voluntary attestation process. We have developed an attestation form" that can be found on our Provider Based home web page to assist our providers in this process. It is important that all questions are fully completed and documented. The Fiscal Intermediary is responsible for ensuring all information is submitted to make a sound recommendation to CMS. Providers are no longer required to apply for and receive a provider-based determination for their facilitates prior to billing for services in those facilitates as provider-based.
However, under §413.65(b)(3), a provider may choose to obtain a determination of provider-based status by submitting an attestation stating that the facility meets the relevant provider-based requirements (depending on whether the facility is located on campus or off campus). Providers who wish to obtain such a determination of provider-based status for their facilities after October 1, 2002 should do so through the self-attestation process.
Benefits of self-attesting
Effective October 1, 2002 (or, for grandfathered facilities effective for the potential main provider's first cost reporting period starting on or after July 1, 2003), an attestation of provider-based status, if approved, would result in a determination that a facility or organization is provider-based. If CMS subsequently discovers that the facility for which an attestation has been made and approved in fact does not meet the provider-based rules, then CMS would not recover all past payments for periods subject to reopening, but instead would recover only the difference between the amount of payment that actually was made since the date the complete request for a provider-based determination was submitted and the amount of payments that CMS estimates should have been made in the absence of compliance with the provider-based requirements. At the time that CMS determines that a facility that submitted a complete attestation is actually not provider-based, payment would continue for up to 6 months but only at a reduced rate as described at §413.65(j)(5).
It could benefit the provider to self-attest and obtain a determination because, under §413.65(l)(1), treatment of a facility as provider-based would cease only with the date that CMS determines that the facility no longer qualifies for provider-based status, if the reason the provider-based criteria are not met is a material change in the provider-facility relationship that was properly reported to CMS. By contrast, a provider that did not seek such a determination or obtained a determination but failed to report a material change in its relationship with the facility, could face a partial recovery of past payments. Also, a provider that does not seek a provider-based determination and incorrectly bill as such could be subject to the partial recovery of payments for all cost reporting periods subject to reopening in accordance with 42 CFR §405.1885 and §405.1889.
Self Reporting
A main provider that creates or acquires a facility or organization for which it wishes to claim provider-based status, including any physician offices that a hospital wishes to operate as a hospital outpatient department or clinic, is not required but it is recommended that it report its acquisition of the facility or organization to CMS if the facility or organization is located on or off the campus of the provider, or if inclusion of the costs of the facility or organization in the provider's cost report would increase the total costs on the provider's cost report by at least 5 percent, and must furnish all information needed for a determination as to whether the facility or organization meets the requirements for provider-based status. We recommend that providers submit attestations for both on-campus and off-campus facilities. However, it is only required for off-campus entities.
Also, it is recommended that a main provider that has had one or more facilities or organizations considered provider-based report to CMS any material change in the relationship between it and any provider-based facility or organization, such as a change in ownership of the facility or organization or entry into a new or different management contract that could affect the provider-based status of the facility or organization.
In addition to completing this attestation, documentation that demonstrates that the provider-based requirements have been met, i.e., organizational chart, etc., must be submitted with this request. CMS has the discretion to request additional information not listed on the provider-based application in order to further substantiate compliance with 42 CFR §413.65 or §413.174. Any special circumstances should be fully explained in a cover letter with this request.
Page Last Updated: Tuesday, 15-Jul-2008 10:37:31 CDT
