STARK BASIC TRAINING - The American Health Lawyers Association

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• Old Rule ENTITY • Person or entity to whom payment is made • New Rule (effective 10/1/09) • Person who presents claim to Medicare, AND • Person who has “performed services billed as DHS” 31 ENTITY • No regulatory definition of what it means to “perform” services billed as DHS • See preamble commentary … • Does physician “do the medical work” for the service and could she bill for it? • Entity does not “perform” DHS if it only: • Leases or sells space/equipment • Furnishes supplies • Provides management or billing services; or • Provides personnel 32 16
ENTITY • Multiple DHS entities can receive a referral • Must do separate Stark analysis for referrals to each DHS entity • Expanded definition effectively prohibits physician ownership of entities that perform DHS “under arrangements” with a hospital 33 RESOURCES • 411.351 definition • Phase I (p.943) • Phase II (pp. 16106-07) • Phase III (pp. 51014-15) • CY09 IPPS (73 FR 48721-33) for current law 34 17
Page 1 and 2: STARK BASIC TRAINING Health Care Co
Page 3 and 4: THE SOLUTION: MULTIPLE STATUTES •
Page 5 and 6: WHAT’S NOT PROHIBITED • Physici
Page 7 and 8: THREE QUESTIONS 1. Is there a refer
Page 9 and 10: IMPUTED REFERRALS • Consulting ph
Page 11 and 12: WHAT’S NOT A REFERRAL • Request
Page 13 and 14: DESIGNATED HEALTH SERVICES (Not eve
Page 15: RESOURCES • 1877(h)(6); 411.351
Page 19 and 20: DIRECT DOCTOR DHS ENTITY (No interv
Page 21 and 22: ICA EXCEPTION • Compensation must
Page 23 and 24: “STAND IN THE SHOES” Physician
Page 25 and 26: RESOURCES • 1877(a)(2), (h)(1)
Page 27 and 28: “SERVICE-BASED” EXCEPTIONS •
Page 29 and 30: FMV RESOURCES • Phase I (pp. 944-
Page 31 and 32: GROUP PRACTICE CRITERIA • Group p
Page 33 and 34: GROUP PRACTICE CRITERIA • Share o
Page 35 and 36: 69 IN-OFFICE ANCILLARY SERVICES EXC
Page 37 and 38: IOAS EXCEPTION Where Are Services P
Page 39 and 40: IOAS EXCEPTION How Are Services Bil
Page 41 and 42: RECRUITMENT • Payments made to in
Page 43 and 44: PSA EXCEPTION • Arrangement is se
Page 45 and 46: RENTAL EXCEPTIONS • Lease is in w
Page 47 and 48: EMPLOYMENT EXCEPTION • Employment
Page 49 and 50: Non-Monetary Compensation Exception
Page 51 and 52: NON-MONETARY COMPENSATION EXCEPTION
Page 53 and 54: MEDICAL STAFF INCIDENTAL BENEFITS E
Page 55 and 56: TIPS • Always draw a diagram •

STARK BASIC TRAINING - The American Health Lawyers Association

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