A recent advisory opinion from the Centers for Medicare & Medicaid Services may allow all radiology practices increasingly greater capacity to structure their relationships and organization, according to experts’ advice.
The Stark Law follows a strict structure and forbids doctors from referring Medicaid or Medicare patients for health-related imaging and similar designated services if the concerned referrer has certain financial relationships with this entity. But, there is one exception for entities that employ multiple physicians qualifying for a “group practice.”
In the latest advisory, CMS also disclosed that the exception only applied to those physician groups that furnish imaging and related services through an entirely owned and managed subsidiary practices separately enrolled in Medicare. This opinion further provides a greater leeway, thus allowing the physician practices to use their subsidiaries for various markets or even different arrangements for payers, according to Danielle Sloane, a Bass Berry & Sims attorney.
This news is highly meaningful for recent radiology practices offering international services.
Sloane told Radiology Business, “For only diagnostic practices where they receive referrals from other outside sources treating physicians, this may not be so important. However, for other IR practices providing drugs, imaging, and other services in their practice, it could be significant – typically for the ones involved in major consolidated transactions.
Finally, Sloane also added that the advisory only approved a particular entity enrolled in the Medicare as well as billing like a physician practice to own similar other entities that also enrolled and were billing as a physician practice. She expressed, “But, CMS is likely to be threading this needle by calling its parent as “group practice” instead of “subsidiaries.”
“It further demonstrates the continued recognition of CMS that this healthcare industry has been innovating and the requirement for flexibility so that it can foster the innovation,” Sloane added. “This, however, would not increase enforcement because it is just a positive advisory. Simply put, it outlines the permissible limits but does not highlight the problematic structure.”
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