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Category Archives: Ancillary Services

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Pennsylvania Department of Health Clarifies Clinical Laboratory Law

Posted in Ancillary Services, Pennsylvania Legislation

On December 18, 2013, Pennsylvania Act 122 amended the Pennsylvania Clinical Laboratory Act to, among other things, impose licensure requirements on out of state clinical laboratories and to place certain prohibitions on physician financial arrangements with labs.  Among other things, Act 122 prohibits the payment or receipt of commissions, bonuses, kickbacks or fee-splitting arrangements and prohibits laboratories from… Continue Reading

Does Your Group Practice Income Division Formula Comply with Stark

Posted in Ancillary Services, Fraud and Abuse

Many physicians I speak with are still surprised to learn that the federal Stark statute imposes restrictions on income division within group practices.  These restrictions only apply to profits generated from any of the Stark “designated health services” and only those that are covered by Medicare and Medicaid (including managed care), but if your group provides… Continue Reading

Do Your Due Diligence – or Get Denied (by NJ Medicaid)

Posted in Ancillary Services, Uncategorized

By Michael J. Coco What providers and pharmacists don’t know about their employees can hurt them.  That’s the hard lesson learned by a New Jersey pharmacy that had no reason to think the pharmacy it purchased came with an experienced, licensed pharmacist employee with an unsuspected criminal background.  Providers should know that falsifying documents, records… Continue Reading

The Race to Complete Physician-Owned Hospitals Is On

Posted in Ancillary Services, Health Reform, Medicare

  For physicians in the process of developing physician-owned hospitals, the race is on to get those facilities up and running by December, 2010. The recently enacted “Health Care and Education Affordability Reconciliation Act of 2010” amends the Stark law to once and for all prohibit physician-owned specialty hospitals unless: (1) the hospital has a… Continue Reading

New Requirements on Stark In-Office Ancillary Services

Posted in Ancillary Services, Fraud and Abuse, Health Reform, Medicare

Among its many provisions, the newly signed Patient Protection and Affordable Care Act has imposed a new requirement on physicians who rely on the Stark "In-Office Ancillary Services" exception.  Physicians who refer patients for CT, MRI or PET (or other Stark services as designated by the Secretary of HHS) that will be provided by the referring physician’s practice… Continue Reading

Advanced Imaging Suppliers To be Accredited by January 2012

Posted in Ancillary Services, Billing & Reimbursement, Medicare

Under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), all Medicare suppliers of the technical component of advanced imaging services have until by January 1, 2012 to become accredited by an accreditation organization designated by the Secretary of Health and Human Services . This includes physicians, non-physician practitioners, and physician and non-physician… Continue Reading

Diagnostic Imaging Centers Continue to Struggle

Posted in Ancillary Services

As was predicted by many, the Deficit Reduction Act is continuing to cause a major shake-out in the imaging center industry.  According to the Florida Business Journal, a major Florida-based imaging center company has filed for Chapter 11 reorganization and will close 5 of its 17 centers.  As this trend continues, many physicians who invested in centers in… Continue Reading

Dems’ Medicare Bill Would Prohibit Physician Investment in Hospitals

Posted in Ancillary Services, Medicare

Much has been in the news lately about the Children’s Health and Medicare Protection (CHAMP) Act of 2007 recently introduced by the House democrats.   The Bill’s proponents claim that if enacted it will provide insurance coverage for millions of children and improve and strengthen Medicare for America’s seniors and people with disabilities.  What Physicians — particularly surgeons… Continue Reading

Thinking of Joint Venturing with Your Hospital?

Posted in Ancillary Services, Fraud and Abuse

As lucrative ancillary services continue shift from hospitals to outpatient sites, hospitals are anxious to find ways to keep they’re hand in the mix.  Not surprisingly, physician-hospital joint ventures are all the rage.  While such ventures can be legally structured, the stakes of failing to comply with applicable legal requirements can be very high.  For important considerations… Continue Reading

Final Stark Regulations Delayed — Again!

Posted in Ancillary Services, Fraud and Abuse, Medicare

The Centers for Medicare and Medicaid Services (CMS) announced today in the federal register that it will delay publication of the much anticipated Phase III final Stark self-referral regulations (which were due out by today) until March 23, 2008. According to CMS, the delay is necessary in order to allow time to review and consider the extensive… Continue Reading

Controversial IDTF Guidelines Rescinded!

Posted in Ancillary Services, Billing & Reimbursement, Medicare

On February 19, 2007 (but effective retroactively to January 26, 2007), the Centers for Medicare and Medicaid Services (CMS) rescinded the controversial IDTF transmittal referrenced in the February 18, 2007 entry on this Blog.  A copy of the notice can be found here: Transmittal 187.  Those guidelines would have imposed major new conditions on independent diagnostic testing facilities… Continue Reading

Bill Proposes To Reinstate Pennsylvania CON and Prohibit Self-Referrals

Posted in Ancillary Services, Pennsylvania Legislation

A recent bill proposed by the Pennsylvania House of Representatives would, among other things, reinstate the Certificate of Need (CON) program in Pennsylvania.  Specifically, House Bill 305, introduced on February 7, 2007, would require anyone proposing to make capital expenditures in excess of $500,000 for replacement technology or $1,000,000 for equipment or improvements in connection… Continue Reading

Thinking About Building or Investing in a Surgery Center?

Posted in Ancillary Services

Building and/or investing in an ambulatory surgery center (ASC) is a great way to gain control over the surgical side of your practice and can also be an excellent source of ancillary revenue.  However, start-up costs can be prohibitive and building and running an ASC can be time consuming.  Not surprisingly, many physicians are tempted to "partner" with other investors as… Continue Reading