Stark Basics

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Author:
luke242
ID:
117657
Filename:
Stark Basics
Updated:
2011-11-19 17:56:24
Tags:
stark health law
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Description:
This provides the basics of stark.
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  1. What is the anti-kickback rule?
    Providers may not knowingly and willfully accept remuneration in return for generating Medicare/Medicaid business
  2. What are the elements to the personal service arrangment?
    • (1) in writing
    • (2) signed
    • (3) specifies the services covered
    • (4) covers all the services provided by physician to entity
    • (5) services do not exceed reasoonable and necessary
    • (6) at least 1 year
    • (7) compensation (i) set in advance, (ii) does not exceed FMV, and (iii) does not take into account volume or value of referrals (except for physician incentive plan)
  3. What are the elements of the bona fide employment exception?
    • (1) Employment for indentifiable services
    • (2) FMV compensation
    • (3) Not based on volume or value of referrals,
    • (4) except for productivity bonuses based on services personally performed by physician
  4. What are the elements of an equipment lease?
    • (1) in writing
    • (2) signed
    • (3) identifies the equipment covered
    • (4) at least 1 year
    • (5) only reasonsable and necessary equipment
    • (6) equipment used exclusively by leasee during leased time
    • (7) rent set in advance
    • (8) rent is FMV
    • (9) rent not based on volume or value of referrals
  5. What are the elements to the office space rental?
    • (1) in writing
    • (2) signed
    • (3) identifies the premises
    • (4) at least 1 year
    • (5) only reasonsable and necessary space
    • (6) space used exclusively by leasee during leased time
    • (7) rent set in advance
    • (8) rent is FMV
    • (9) rent not based on volume or value of referrals
  6. What is the in office ancillary care exception?
    • (1) Services furnished personally by (i) the referring physician, (ii) a physician in the referring physician's group, or (iii) an individual supervised by (i) or (ii)
    • (2) at a specific location
    • (3) billed by the physician, or other appropriate party
  7. What are physician services under the physician services exception?
    42 CFR 410.20(a) Medicare Part B pays for physicians’ services, including diagnosis, therapy, surgery, consultations, and home, office, and institutional calls.
  8. Physician Services Exception
    Physician services performed personally or under the supervision of another physician in the referring physician's group practice
  9. What is the definition of a group practice?
    • (1) A single legal entity
    • (2) Two or more physicians as owners or employees who (a) provide and (b) bill substantially all their care through the practice
    • (3) Sharing of income and overhead (a) prospectively (b) using a method blessed by the statute
    • (4) Unified business
  10. What are the exceptions to the definition of a referral?
    • DHS personally performed by the physician
    • Or
    • Certain requests by pathologists, radiation oncologists,
    • radiologists
  11. What is a referral (not including exceptions)?
    • Request, order, or certifying of need for DHS (whether
    • written, oral, or electronic) payable by medicare
  12. Feared Approa(c)h Ahead
    Clinical Laboratory Services
  13. Feared Approac(h) A(h)ead
    • Home health services
    • AND
    • Inpatient and outpatient hospital services
  14. Feared Appr(o)ach Ahead
    Outpatient speech-language pathology services
  15. Feared A(pp)roach Ahead
    • Physical therapy services.
    • AND
    • Prosthetics, orthotics, and prosthetic devices and supplies.
  16. Feare(d) Approach Ahea(d)
    • Outpatient prescription drugs
    • AND
    • Durable medical equipment and supplies
  17. Types of ownership interests
    Investment, Ownership, Compensation
  18. Fea(r)ed App(r)oach Ahead
    • Radiation therapy services and supplies
    • AND
    • Radiology and certain other imaging services
  19. (F)eared Approach Ahead
    • [F]eeding
    • Parenteral and enteral nutrients, equipment, and supplies.
  20. What does each letter in the DHS acrynom (Feared Approach Ahead) stand for?
    • [F]eeding
    • E
    • A
    • [R]adiation therapy
    • E
    • [D]rugs

    • A
    • [P]hysical
    • [P]rosthetics
    • [R]adiology and imaging
    • [O]ccupational
    • A
    • [C]linical
    • [H]ome

    • A
    • [H]ospital
    • E
    • A
    • [D]urable
  21. What is the DHS acrynom?
    Feared Approach Ahead, without AE
  22. How many DHS categories?
    • Thirteen
    • ... an unlucky number
    • or
    • 10 + DHS (3)
  23. How many elements in a Stark violation?
    • Six or
    • Stark (5) + exception (1) = 6
  24. What are the elements of a Stark violations?
    • Prohibits a:
    • (1) physician from making
    • (2) referrals for certain
    • (3) designated health services (DHS)
    • (4) payable by Medicare
    • (5) to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation),
    • (6) unless an exception applies.

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