Because our regulations define specific DUS codes by the CPT and HCPCS, we publish annually an updated list of codes for the relevant DUS in the final rule of the doctors` fee schedule. [For more information, see the « List of Codes for a Specific DHS » in the navigation tool on the left side of this page.] The following companies in these difficult legal cases knew what they were getting into. Let`s see where that led them. The final regulations of Phase I define the term « physician » as a doctor of medicine or osteopathy, a doctor of dental surgery or dentistry, a doctor of podiatry, a doctor of optometry or a chiropractor. The Stark Act defines financial relationships as generally including ownership/investment interests and compensation agreements between a physician (or a member of the physician`s immediate family) and an entity provided by DHS. These agreements and the financial relationships associated with them may be direct or indirect. It is essential to understand the nature of the financial relationship in question, as it determines the exceptions that are available under Stark Law. A « financial relationship » is defined as a direct or indirect interest or interest in an entity through equity, debt or other means, or a direct or indirect compensation agreement with an entity. Clearly defines « referral » broadly to include a physician`s request for an item or service payable under Medicare or Medicaid (including a physician`s request after consultation with another physician and any tests or procedures ordered or performed by such another physician) or a physician`s request to create a care plan, which includes the provision of a DHS. The definition of « reference » does not include services provided personally by a referring or prescribing physician (but not services provided by employees or other members of the same joint practice as the referring physician).

As a result, doctors who personally perform the DHS they order for their patients can take precautions without having to worry about possible Stark violations. The term « immediate family member » is generally defined as a husband or wife; birth or adoptive parent, child or sibling; step-parent, step-son, half-brother or half-sister; stepfather, mother-in-law, son-in-law, daughter-in-law, brother-in-law or sister-in-law; grandparent or grandchild; and spouse of a grandparent or grandchild. Overall, Stark`s Law prevents a physician from referring patients to DHS if there is a financial relationship between the physician and the health care institution, the immediate family member, and the health care facility. Under this law, financial relationships are defined as a physician or immediate family member who A) owns or invests in the business (ownership or investment is also referred to as equity or debt capital and includes any interest in an entity that owns or invests in the facility providing the designated health care, DHS) B) a remuneration agreement between the physician (or immediately). Family member) and the company. While the inclusion criteria appear to be relatively open and extensive, there are several notable exceptions to this bill. Some of the common exceptions are:[2] (This is a non-exhaustive list) The Physician Self-Referral Act – the Stark Act – refers to section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn). Stark`s Law is defined as a set of regulations that prohibit the self-referral of physicians under federal law.

It restricts all financial and commercial transactions in which doctors may be involved. Those who defend the practice argue that these problems are not widespread. They argue that physicians who own, invest in, or operate medical facilities address a need for medical services that would otherwise not be met, particularly in medically underserved areas. In addition, it often happens that doctor-owned businesses are a more cost-effective alternative to facilities located in hospitals. This is mainly due to the higher overhead costs that hospitals have to pass on to their services. Healthcare experts agree that information technology is needed to streamline hospital processes, including those related to compliance and stark law. Some electronic health record companies help health systems collect, organize, and store data. There are several technological solutions that specifically automate doctors` time tracking and eliminate the risk of violating the Stark Law. DHS stands for one of the following services (except those provided as emergency medical services outside the United States): Even with the best of intentions, it`s still possible that you`re violating the Stark Law if you don`t understand its implications.