Since the beginning of the COVID pandemic in 2020, we have seen the advent of new regulations that apply to fitness entities, and more. Telemedicine, others are transient or would have already ended. Health care providers should be vigilant for transitory changes that are coming to an end and verify that they have understood any deviations or changes from the law on which they relied in the past.
A notable example of a law replacing COVID is the Medical Self-Referral Act, commonly referred to as the Stark Act (see 42 CFR §411. 350, et seq. ). Generally, this law prohibits physicians from referring Medicare patients to an entity in which the physician or a member of the immediate circle of family members has a monetary interest in certain designated fitness facilities (DHS).
To comply with Stark, strict requirements must be met. One such limitation is precisely that self-referred DHS can be physically provided through physicians in an organization’s practice. “same building” or a “centralized building” so that an organization’s practice can comply with Stark’s exception of “auxiliary services in the office. “
To aid healthcare practices during the COVID pandemic, state and federal regulators have temporarily waived existing regulations to allow healthcare providers to adapt to COVID restrictions. as “same building” or “centralized building” for Stark’s purposes. This waiver allowed, for example, practices to offer Medicare-paid pathology or radiology facilities at any location without violating Stark for failing to comply with office-based ancillary facilities. exception. Doctors were given the freedom to supply such facilities from a variety of locations. Currently, this exemption is still in force.
While the Stark Act was relieved by COVID, other health care laws were not, creating a possibility of unintentional violations.
For example, Medicare’s Margin Payment Limitations (AMPL) rule (see 42 CFR 414. 50), which was never waived, remains in full force and effect.
AMPL is a Medicare payment limitation rule that applies whenever a practice orders a service and also serves as a billing office (the office makes a request for Medicare payment), but the service is done through a doctor who does not “share an office. “with the practice of billing.
If an interim physician supplies a practice with the billing office, we decide on whether: (1) the interim physician provides “virtually all” of the physician’s professional facilities for the billing office (i. e. , at least 75% of the interim physician’s services). professional facilities); or (2) the interim physician provides the service on-site or “in the office” billing practice.
When medical practices violate AMPL, the amounts they earn may be considered overpaid and must be reimbursed to Medicare.
When an office hires an outside physician to interpret radiology and pathology checks, the office does not have enough volume to assist the acting physician 75% of the time, and the interim physician most likely provides facilities for multiple offices and would not travel to be on-site at each location. When this occurs, payment to the billing workplace is limited to the lesser of: (i) the interim physician’s net rate to the billing workplace; (ii) the actual pricing of the Medicare billing practice; or (iii) the amount of the check payment schedule that would be allowed if the treating physician billed Medicare directly.
Therefore, the location requirements were eliminated for Stark, external facilities covered by AMPL still had to be properly billed in accordance with legal requirements. Unfortunately, as a result of Stark’s exemption, many practices assumed that AMPL did not apply or perhaps not even aware of AMPLE’s needs and did not handle billing needs well once staff moved offsite.
Even among fitness advocates, there is confusion about the application of those rules, the Centers for Medicare.
If your practice violated the AMPL or any other legal ideas that COVID has raised, you may need to identify and return bills to Medicare or other payers.
All indications are that COVID exemptions expire as soon as the official “public fitness emergency” ends. Many repeals of the legislation will occur at short notice, and enforcement is expected to resume almost immediately. A specific fear domain is for professionals who have brought telemedicine. in their practices amid the pandemic and would possibly find those practices no longer compliant with post-COVID billing, privacy, and prescribing regulations.
While it’s unclear when the official public fitness emergency will end and life will return to “normal,” practices will need to prepare ahead of time and minimize legal dangers and monetary penalties, which can be significant. Also, for any practice that is contemplating a sale transaction lately, compliance in those spaces is essential. Discovering that a practice has failed to provide or invoice facilities in accordance with applicable law can make it a less purchase target and have a significant impact on purchase conditions.
Follow Medscape on Facebook, Twitter, Instagram and YouTube
© 2022 WebMD, LLC
American Health Lawyers Association; Member, Illinois Health Bar Association; Current Advisory Board Member, DePaul College of Law Health Law Institute; Shareholder, Head of Health Law Group, Roetzel, Chicago, IllinoisDisclosure: Ericka L. Adler, JD, LL. M, disclosed any applicable monetary relationship.
You’ve already decided on My Alerts
Click on the subject line below to receive emails when new items become available.