Physician Acknowledgement

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The law requires hospitals that are paid under the prospective payment system (PPS) to obtain a signed acknowledgement from physicians who have admitting privileges at a particular hospital. The physician must complete the acknowledgement when he or she receives admitting privileges or before or at the time the doctor admits his or her first patient to the hospital.

When submittimg a claim, the hospital must have on file a signed and dated acknowledgement from the attending physician that the physician received the notice. Existing acknowledgements from physicians already on staff remain in effect as long as the physician has admitting privileges at the hospital. Your state’s Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) monitors this process annually.

You can identify your state’s BFCC-QIO by referencing listing below. 

BFCC-QIO Contact Information by Region or State

Region 1:
Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont 

Region 2:
New Jersey, New York, Puerto Rico, Virgin Islands

Region 3:
Delaware, DC, Maryland, Pennsylvania, Virginia, West Virginia

Region 4:
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

Region 5:
Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin

Region 6:
Arkansas, Louisiana, New Mexico, Oklahoma, Texas

Region 7:
Iowa, Kansas, Missouri, Nebraska

Region 8:
Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

Region 9:
Arizona, California, Hawaii, Nevada, Guam, N. Mariana Islands, American Samoa

Region 10:
Alaska, Idaho, Oregon, Washington