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Stark Law

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rexandfoxy View Drop Down
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Joined: Aug 28 2009
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  Quote rexandfoxy Quote  Post ReplyReply bullet Topic: Stark Law
    Posted: Aug 28 2009 at 2:52pm
How does this law effect perfusion practice owned by a clinic?
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wlparker View Drop Down
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  Quote wlparker Quote  Post ReplyReply bullet Posted: Aug 31 2009 at 2:43pm

The Stark Law is a law involving Medicaid or Medicare patients; and was created to restrict physician referrals that have the potential to be financially beneficial to that physician and therefore have the possibility of influencing quality of patient care, e.g. an orthopedic surgeon referring and billing for patient services at a physical therapy clinic, that is owned by that same orthopedic surgeon (unless an exception applies).

 

The exact wording of the law is: (a) Prohibition on referrals. Except as provided in this subpart, a physician who has a direct or indirect financial relationship with an entity, or who has an immediate family member who has a direct or indirect financial relationship with the entity, may not make a referral to that entity for the furnishing of DHS (Designated Health Service) for which payment otherwise may be made under Medicare. A physician's prohibited financial relationship with an entity that furnishes DHS is not imputed to his or her group practice or its members or its staff. However, a referral made by a physician's group practice, its members, or its staff may be imputed to the physician if the physician directs the group practice, its members, or its staff to make the referral or if the physician controls referrals made by his or her group practice, its members, or its staff. 

 

The criteria to determine whether a referral is inappropriate can be determined by submitting an advisory opinion request to:

Centers for Medicare & Medicaid Services, Department of Health and Human Services, Office of Financial Management, Division of Premium Billing and Collections, Mail Stop C3–09–27, Attention: Advisory Opinions, 7500 Security Boulevard, Baltimore, MD 21244–1850.

 

To date there has been no request, and therefore no ruling on perfusion services being owned and referred to by a physician.  To make a request to determine whether a specific perfusion service, would or would not, be allowed to be owned by a physician or physician group, a fee of $250 would need to be submitted, along with details of the business arrangement.  The case would be assessed and a ruling would be made.  Currently "typical" rulings are being determined in approximately 1 year.    

 

Before submitting an advisory opinion request, I would suggest you read over the portion of the preamble to the August 19, 2008 final rule dealing with the revised definition of “entity.”

 

http://edocket.access.gpo.gov/2008/pdf/E8-17914.pdf   The discussion of “entity” begins on page 48721 of the Federal Register (or page 289 of the document).

 

Also, here is the link to the regulations regarding advisory opinions.  You will need to scroll down the page and click on each of the sections in the range from 42 CFR 411.370-411.389.

 

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=9768a243c827c454cd6bb8d1ade382ce&tpl=/ecfrbrowse/Title42/42cfr411_main_02.tpl

 

If you have any questions, you can email me directly at the email below.

 

W Lane Parker, CCP

wlparker@uci.edu

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