Practice Management Alert

Question: Rumors abound that the Stark Law will be subject to the Trump Administration's deregulation agenda. What do I need to know?

Virginia Subscriber

Answer: The American Hospital Association (AHA) President and CEO, Rick Pollack, had CMS Administrator Seema Verma on an AHA town hall webcast in late January, where they discussed regulations in health care and moving toward a value-based payment system.

According to an AHA news release, during the webcast, Verma acknowledged what hospitals and other healthcare entities consider challenges with Stark Law regulations, saying, "I think the Stark Law was developed a long time ago, and given where we're going in terms of modernizing [Medicare] and the payment systems we are now operating under now, we need to bring along some of those regulations."

According to the release, Verma added that Congress might have to act to provide full relief from the Stark Law. You can watch the full webcast here: http://windrosemedia.com/windstream/aha/011718/.

In the meantime, make sure you're abiding by Stark Law regulations. Parts of the Stark Law were enacted in 1989, but in its current form, the following are considered designated health services, according to CMS:

• Clinical laboratory services;
• Physical therapy services;
• Occupational therapy services;
• Outpatient speech-language pathology services;
• Radiology and certain other imaging services;
• Radiation therapy services and supplies;
• Durable medical equipment and supplies;
• Parenteral and enteral nutrients, equipment, and supplies;
• Prosthetics, orthotics, and prosthetic devices and supplies;
• Home health services;
• Outpatient prescription drugs; and
• Inpatient and outpatient hospital services.

According to CMS' website on Physician Self-Referral, Stark Law, as it stands:

1. Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation), unless an exception applies.

2. Prohibits the entity from presenting or causing to be presented claims to Medicare (or billing another individual, entity, or third-party payer) for those referred services.

3. Establishes a number of specific exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse.