This PowerPoint file is a supplement to the video presentation. Some of the educational content of this program is not available solely through the PowerPoint file. Participants should use all materials to enhance the value of this continuing education program.
Physician 20711 Deborah Dabbs, MBA, CHC, MT(ASCP)SM has no relevant financial relationships to disclose. Deborah Dabbs, MBA, CHC, MT(ASCP)SM has read and signed a statement of Evidence-Based Content and a statement of Content Validation acknowledging her responsibility to disclose drug products and/or devices with investigative nature, non-FDA approved uses, or off-label uses to TTUHSC and the participants for this activity.
Physician 20711 Release Date: 12/01/2011 The accreditation for this program is valid through: 11/30/2013
Physician 20711 Stark Law: Part 2 If you have any questions about the program you are about to watch, you may call us at: (800) 424-4888 or fax (806) 743-2233. Direct your inquiries to Customer Service. Be sure to include the program number, title and speaker.
Physician 20711 Stark Law: Part 2 Deborah Dabbs, MBA, CHC, MT(ASCP)SM Corporate Compliance Coordinator UMC Lubbock, Texas
Physician 20711 Objectives 1. Recognize the recent changes and clarifications in the Stark law.
Physician 20711 Objectives 2. Identify Stark law concerning compensation/ remuneration.
Physician 20711 Objectives 3. Indicate Stark law penalties.
Stark Law Stark II Phase III
Stark Law The opinions expressed are those of Centers for Medicare and Medicaid Services (CMS)
Objectives • Indicate the most important changes and additions made by Phase III
Objectives • Identify potential future changes to Stark
Objectives • Recognize that any number of factors can affect the landscape of Stark
Entity Amended • To include a person or entity performing or furnishing designated health services (DHS)
Entity Amended • Must be the person or entity that performs the DHS
Entity Amended • Must be the person or entity that presents a claim for the DHS
Services Provided • Physician owner of an entity providing DHS under arrangements...
Services Provided ...(but not billing for those services) may have a non qualifiable...
Services Provided ...ownership interest in that entity
Services Provided • CMS prohibited under arrangement agreements between hospitals and physicians...
Services Provided ...unless they meet a direct compensation exception under Stark
Group Practice • Modified definition of physician in group practice; includes independent contractors
Group Practice • An independent contractor physician is only considered a physician in the group practice...
Group Practice ...when he/she is performing services in the group’s facilities
Group Practice • Encompasses only members (owners or employees) and independent contractors
Group Practice • Productivity bonuses could be based directly on incident to services
Group Practice • Incident to services are incidental to the physician’s personally performed services
Group Practice • Profits must be allocated in a manner that does not directly relate to DHS referrals
Stand in the Shoes • A physician organization is defined as:
Stand in the Shoes • a physician • professional corporation with a single physician as the sole owner
Stand in the Shoes • a physician practice • - a group practice
In-officeAncillary Services • Physicians sharing a DHS facility in the same building must control the facility...
In-officeAncillary Services ...and the staffing at the time the DHS is furnished to the patient
In-officeAncillary Services • Common per-use fee arrangements are unlikely to satisfy...
In-officeAncillary Services ...the supervision requirements of the in-office ancillary services exception
In-officeAncillary Services • These arrangements must fully comply with the in-office ancillary services...
In-officeAncillary Services ...exception in the real world and not just on paper
FMV • CMS eliminated the voluntary safe harbor provision within the definition of FMV...
FMV ...applicable to hourly payments to physicians for their personal services
Fair Market Value (FMV) 2 Methods for Calculating
FMV • Hourly payment to average hourly rate for emergency room (ER) physician services in the relevant market,...
FMV ...provided at least 3 hospitals with ER services were in the market
FMV • Based on 50th percentile of national compensation level for physician in same specialty...
FMV ...using 4 of 6 specified salary surveys and dividing by 2,000 hours to establish hourly rate
FMV • Providers are responsible for FMV calculations…
FMV …blind acceptance of an independent appraisal could land you in the hot seat