Hurley Medical Center
Medicare/Champus NoticePreviously, physicians were required to sign an attestation statement for each discharge before submitting a Medicare claim. With this attestation, physicians certify the accuracy of the principal and secondary diagnosis and the major procedures performed for each patient during the inpatient stay. Rather than signing an attestation for each discharge, attending physicians, as a condition for payment by the Medicare/Champus programs, are required to sign and hospitals are required to maintain a signed acknowledgement statement one time only. The acknowledgements state that the physician has received the following notice. If you have any questions or comments, please contact Belle Bell, Director, Health information Services at (810) 262-9548.NOTICE TO PHYSICIANS“Medicare/Champus payment to hospitals is based in part on each patient’s principal and secondary diagnosis and the major procedures performed on the patient, as attested to by the patient’s attending physician by virtue of his/her signature in the medical records. Anyone who misrepresents, falsifies, or conceals essential information required for payment of Federal funds may be subject to fine, imprisonment, or civil penalty under applicable Federal laws.”I acknowledge that I received this notice.Print Name: Click here to enter text.Signature:_____________________________________ Date: Click here to enter a date. ................
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