CMS Pub. 100-02, ch. 6, § 20.3

Source: 42 CFR 410.2 and 482.12

A hospital outpatient “encounter” is a direct personal contact between a patient and a

physician, or other person who is authorized by State licensure law and, if applicable, by

hospital or CAH staff bylaws, to order or furnish hospital services for diagnosis or

treatment of the patient.

The conditions of participation for hospitals under 42 CFR 482.12(c)(1)(i) through

(c)(1)(vi) require that every Medicare patient is under the care of a doctor of medicine or

osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine,

a doctor of optometry, a chiropractor, or a clinical psychologist; each practicing within

the extent of the Act, the Code of Federal Regulations, and State law. Further, 42 CFR

482.12(c)(4) requires that a doctor of medicine or osteopathy must be responsible for the

care of each Medicare patient with respect to any medical or psychiatric condition that is

present on admission or develops during hospitalization and is not specifically within the

scope of practice of one of the other practitioners listed in 42 CFR 482.12(c)(1)(i)

through (c)(1)(vi).