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20711

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  1. 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.

  2. 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.

  3. Physician 20711 Release Date: 12/01/2011 The accreditation for this program is valid through: 11/30/2013

  4. 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.

  5. Physician 20711 Stark Law: Part 2 Deborah Dabbs, MBA, CHC, MT(ASCP)SM Corporate Compliance Coordinator UMC Lubbock, Texas

  6. Physician 20711 Objectives 1. Recognize the recent changes and clarifications in the Stark law.

  7. Physician 20711 Objectives 2. Identify Stark law concerning compensation/ remuneration.

  8. Physician 20711 Objectives 3. Indicate Stark law penalties.

  9. Stark Law Stark II Phase III

  10. Stark Law The opinions expressed are those of Centers for Medicare and Medicaid Services (CMS)

  11. Objectives • Indicate the most important changes and additions made by Phase III

  12. Objectives • Identify potential future changes to Stark

  13. Objectives • Recognize that any number of factors can affect the landscape of Stark

  14. Entity Amended • To include a person or entity performing or furnishing designated health services (DHS)

  15. Entity Amended • Must be the person or entity that performs the DHS

  16. Entity Amended • Must be the person or entity that presents a claim for the DHS

  17. Services Provided Under Arrangements

  18. Services Provided • Physician owner of an entity providing DHS under arrangements...

  19. Services Provided ...(but not billing for those services) may have a non qualifiable...

  20. Services Provided ...ownership interest in that entity

  21. Services Provided • CMS prohibited under arrangement agreements between hospitals and physicians...

  22. Services Provided ...unless they meet a direct compensation exception under Stark

  23. Group Practice • Modified definition of physician in group practice; includes independent contractors

  24. Group Practice • An independent contractor physician is only considered a physician in the group practice...

  25. Group Practice ...when he/she is performing services in the group’s facilities

  26. Group Practice • Encompasses only members (owners or employees) and independent contractors

  27. Group Practice • Productivity bonuses could be based directly on incident to services

  28. Group Practice • Incident to services are incidental to the physician’s personally performed services

  29. Group Practice • Profits must be allocated in a manner that does not directly relate to DHS referrals

  30. Stand in the Shoes • A physician organization is defined as:

  31. Stand in the Shoes • a physician • professional corporation with a single physician as the sole owner

  32. Stand in the Shoes • a physician practice • - a group practice

  33. In-office Ancillary Services

  34. In-officeAncillary Services • Physicians sharing a DHS facility in the same building must control the facility...

  35. In-officeAncillary Services ...and the staffing at the time the DHS is furnished to the patient

  36. In-officeAncillary Services • Common per-use fee arrangements are unlikely to satisfy...

  37. In-officeAncillary Services ...the supervision requirements of the in-office ancillary services exception

  38. In-officeAncillary Services • These arrangements must fully comply with the in-office ancillary services...

  39. In-officeAncillary Services ...exception in the real world and not just on paper

  40. Personally Furnishing Durable Medical Equipment (DME)

  41. Fair Market Value (FMV)

  42. FMV • CMS eliminated the voluntary safe harbor provision within the definition of FMV...

  43. FMV ...applicable to hourly payments to physicians for their personal services

  44. Fair Market Value (FMV) 2 Methods for Calculating

  45. FMV • Hourly payment to average hourly rate for emergency room (ER) physician services in the relevant market,...

  46. FMV ...provided at least 3 hospitals with ER services were in the market

  47. FMV • Based on 50th percentile of national compensation level for physician in same specialty...

  48. FMV ...using 4 of 6 specified salary surveys and dividing by 2,000 hours to establish hourly rate

  49. FMV • Providers are responsible for FMV calculations…

  50. FMV …blind acceptance of an independent appraisal could land you in the hot seat