Physician Acknowledgement Statement Monitoring
HQSI monitors hospital compliance with Physician Acknowledgement Statements. The Centers for Medicare & Medicaid Services require that hospitals annually submit a list of physicians granted admitting privileges in the prior calendar year (see Code of Federal Regulations for further information). In addition, hospitals are required to have a signed acknowledgement statement from each physician with new admitting privileges (newly credentialed) prior to his/her first admission to the hospital or first claim submission.
Hospitals should print out, complete, and then return the Physician Acknowledgement spreadsheet (available with instructions) to HQSI, along with a photocopy of the signed and dated physician acknowledgement statement for each newly credentialed physician. Physicians that have been credentialed in prior years, and re-credentialed do not need to submit an acknowledgement.
