Radiology Coding and Compliance: Stark and Anti-Markup Laws

We have a number of different things to be looking both from a Stark perspective and anti-markup perspective and so forth. But certainly, any deals involving leases where there might be variable compensation, under arrangement deals with hospitals, technical and professional components with third parties, you know, as we can see all of those now become very high priority healthcare compliance items to look at.

Let's say you have a doctor's office and you have imaging services within that office. So what should you be looking at in terms of that arrangement?

You ought to be looking at whatever contracts you have with radiologist or suppliers of test to be thinking about the anti-markup rule and making sure if there's any referrals going on between the parties that you meet the in-office ancillary exception or whatever applicable exception and that you monitor whether or not you're going to have to get specific accreditation or special certification down the line. You don't have to write now but you may have to do more things to keep, you know, that status to be able to provide CT scans in the office, you know, in the long term as per healthcare guidelines.

We do expect to see a healthcare audit with respect to the anti-markup rule and Stark law. And this may actually be triggered by hospital disclosures. Hospitals are going to be asked to disclose their financial relationships with doctors. That already started last year and we really that's going to continue. And from that information we think audits are going to occur. So, if you got a relationship with a hospital or you have an indirect financial relationship, you may find that you are going to be subject to review because of that information the hospital supplies.

At the same time the hospital in filling out that form may do its own compliance review. So you may be hearing from the hospital saying, “We want to make sure that this contract still works and your relationships with us is still appropriate under Stark.” So that's also going to be behoove you to look at the same thing.

The enforcement's focus as of now, you know, and it may change as we see more of our new administration is that the focus is most likely going to be anti-markup healthcare compliance. The reason is because they really have cut and dried kind of requirements. And you either meet them or you don't. And so, the first thing one ought to do is make sure that each of those requirements, anti-markup and Stark, are fulfilled by your underlying contracts and by how you perform your CT services or other diagnostic services.

Let’s say you have some, you know, compliance work to do. And that includes if you have a contract person providing professional component services or you're providing a PET service to a hospital patient or sharing an office with an IDTF. So these are the kinds of situations you have as we've been talking about you have some work to do. You may have to unwind as per healthcare rules. You may have to modify. You may have to confirm your noncompliance.

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