Does your practice offer MRI, PET or CT imaging to Medicare patients? If so, you may not be following the requirements of the Physician Self-Referral Law (commonly referred to as the “Stark” law). The Stark law regulates certain referrals for certain “designated health services” (which include MRI, PET and CT) that are payable by Medicare. If a referral falls within the Stark law’s prohibitions, the service is not payable by Medicare unless an exception applies. A commonly used exception is the Stark “In-Office Ancillary Services” exception. Since January 1, 2011, practices offering these imaging services and relying on the In-Office Services Exception to comply with the Stark law must provide Medicare patients with a written notice before receiving these services from the practice.
The notice must be written in a manner sufficient to be reasonably understood by all patients and include the following:
- A statement that the patient may receive the imaging service from a provider other than the practice;
- A list of at least five other facilities that provide the service for which the patient is being referred located within 25 miles of the referring physician’s office (if there are fewer than five facilities in this mile range, then all the facilities within 25 miles must be listed); and
- The name, address and telephone number of the other facilities.
Practices who are not routinely providing this notice should implement a protocol to do so immediately. In conjunction with establishing the notice, now also may be a good time to review your practice’s compliance with the Stark law generally.
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