Hospital-based EP
Hospital-based EP. Unless it meets the requirements of 495.5, a hospital-based EP means an EP who furnishes 90 percent or more of his or her covered professional services in sites of service identified by the codes used in the HIPAA standard transaction as an inpatient hospital or emergency room setting in the year preceding the payment year, or in the case of a payment adjustment year, in either of the 2 years before the year preceding such payment adjustment year. (1) For Medicare, this is calculated based on (i) The Federal fiscal year preceding the payment year; and (ii) For the payment adjustments, based on (A) The Federal fiscal year 2 years before the payment adjustment year; or (B) The Federal fiscal year 3 years before the payment adjustment year. (2) For Medicaid, it is at the State's discretion if the data are gathered on the Federal fiscal year or calendar year preceding the payment year. (3) For the CY 2013 payment year only, an EP who furnishes services billed by a CAH receiving payment under Method II (as described in 413.70(b)(3) of this chapter) is considered to be hospital-based if 90 percent or more of his or her covered professional services are furnished in sites of service identified by the codes used in the HIPAA standard transaction as an inpatient hospital or emergency room setting in each of the Federal fiscal years 2012 and 2013.