How are hospital-based eligible professionals defined?
“…an EP (as defined under this section) who furnishes 90 percent or more of his or her covered professional services in a hospital setting in the year preceding the payment year. For Medicare, this will be calculated based on the Federal FY prior to the payment year. For Medicaid, it is at the State’s discretion if the data is gathered on the Federal FY or CY prior to the payment year. A setting is considered a hospital setting if it is a site of service that would be identified by the codes used in the HIPAA standard transactions as an inpatient hospital, or emergency room setting.” There is one exception to this rule. Medicaid EPs practicing in Rural Health Clinics and Federally Qualified Health Centers are exempt from the hospital-based exclusion.
