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Stark Laws

Complying with Stark is very important to CIS.  Knowing your options and staying in compliance is part a healthy practice. 

CMS now includes nuclear medicine services under the designated health services category for purposes of Medicare's federal physician self-referral regulations, which prohibit a physician from referring a Medicare patient to an entity for certain designated health services if the physician has a financial relationship with the entity.

The Stark laws specify two categories of financial relationship that would trigger a self-referral violation: (1) an ownership or investment interest in an entity and (2) a compensation arrangement between a physician and an entity. While the previous statement sounds sweeping in nature, the Stark laws do provide for an exception for physicians who provide ancillary services in their office. In order to qualify for this exception, physicians must meet both CMS' definition of a "group practice" and specific criteria regarding physician supervision, service location and billing. The good news is that CMS did not alter the in-office exception in any way in the final rule. The language specific to these exceptions as it relates to physician supervision and the definition of "group practice" under the in-office exception is listed below.

Section 1877(h)(4)(A) of the Act defines the term group practice as "a group of 2 or more physicians legally organized as a partnership...or similar association - (i) in which each physician who is a member of the group provides substantially the full range of services which the physician routinely provides...through the joint use of shared office space, facilities, equipment and personnel, (ii) for which substantially all of the services of the physicians who are members of the group are provided through the group and are billed under a billing number assigned to the group and amounts so received are treated as receipts of the group, (iii) in which the overhead expenses of and the income from the practice are distributed in accordance with methods previously determined, (iv) except as provided in subparagraph (B)(i) [which relates to profits and productivity bonuses], in which no physician who is a member of the group directly or indirectly receives compensation based on the volume or value of referrals by the physician, and (v) in which members of the group personally conduct no less than 75 percent of the physician-patient encounters of the group practice."

Section 1877(b)(2)(A) of the Act defines qualifying in-office ancillary services as those that are "furnished (i) personally by the referring physician, personally by a physician who is a member of the same group practice as the referring physician, or personally by individuals who are directly supervised by the physician or another physician in the group practice, and (ii)(I) in a building in which the referring physician (or another physician who is a member of the same group practice) furnishes physicians' services unrelated to the furnishing of designated health services, or (II) in the case of a referring physician who is a member of a group practice, in another building which is used by the group practice for the centralized provision of the group's designated health services (other than clinical laboratory services),...In addition, under (b)(2)(B), the services must be billed by the physician performing or supervising the services or the group practice of which such physician is a member under a billing number assigned to the group practice, or by an entity that is wholly owned by the physician or the group practice."