The Centers for Medicare & Medicaid Services (CMS) has issued some alleviation for self-referral reform advocates, and the American College of Radiology (ACR) has provided an overview of key changes to the Stark regulations that affect its members.
On July 31, CMS issued its final rule regarding the Hospital Inpatient Prospective Payment System (IPPS), which included a section that contains many of the anticipated Stark self-referral final rules. In some cases, CMS has decided to give physicians, hospitals and entities, such as imaging centers until Oct. 1, 2009, to restructure current arrangements, while other changes will take effect Oct. 1 of this year, the college said.
The ACR said the agency combines finalizing changes articulated in prior proposed physician fee schedule rules with changes it proposed in April 2007 in the IPPS rule.
The changes represent an array of Stark self-referral concepts, including: ‘stand-in-the shoes’ compensation arrangements; services furnished under arrangements; period of disallowance for noncompliant financial relationships; set-in-advance compensation and percentage-based compensation; ‘per-service’ or ‘per-click’ leasing arrangements; time-block rental arrangements; alternative method for meeting certain exceptions; ownership or investment interest in retirement plans; and burden of proof.
CMS has left untouched its in-office ancillary services exception because it did not propose revisions to the exception either in the calendar year 2008 physician fee schedule final rule or the IPPS fiscal year 2009 proposed rule, which the ACR said will keep the most controversial self-referral exception intact.
The ACR said it will continue to encourage CMS to issue proposed changes to the in-office ancillary service exception which will not take place until at least 2009.
The college also stressed that members should consult with qualified healthcare attorneys to interpret the voluminous new rules and apply them to existing or potential financial arrangements.
The ACR provides further explanation for the CMS IPPS rule, and advice for its members concerning the new rule, on its website.