CMS Condition of Participation for Outpatient Services

482.54 Condition of Participation (CoP): Outpatient Services background

In March 2015, the Centers for Medicare & Medicaid Services (CMS) has advised that hospitals are required to be in compliance with the Federal requirements set forth in the Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid payment. The goal of a hospital survey is to determine if the hospital is in compliance with the CoP set forth at 42 CFR Part 482.

Section 482.54 of the CMS requirements state that hospitals that offer inpatient and outpatient services must verify referrals for services at their hospital are from practitioners that are:

Licensed in, or holds a license recognized in, the jurisdiction where he/she provides care to the patient, and

Acting within his/her scope of practice under State law.

The need to verify non-staff physicians that refer patients requires today’s best healthcare practitioner (HCP) data and information technologies. The MedProID suite of products helps the healthcare industry in achieving the license validation requirements for 482.54 CoP compliance.

482.54 CoP license validation is fully supported across the entire MedProID® suite of solutions, including WebID®, BulkID and WebServicesID®.

To learn more about CMS’ Conditions of Participation (CoP) in order to receive Medicare/Medicaid payments, please visit the CMS website: www.cms.gov

Access to the most updated HCP and HCO licensing data is just a few clicks away

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