How Stark Law Applies to Ultrasound

 

As physicians continue to add in-house diagnostics to the services they offer, care should be taken to ensure compliance with Stark and Anti-kickback legislation. We are proud to say that all of our policies and contracts are compliant with this legislation. The Stark Law provides for an “in-office ancillary exception” in §411.355 and mobile imaging services are covered under section b (iii) which included below:

(b) In-office ancillary services. Services (including certain items of durable medical equipment (DME), as defined in paragraph (b)(4) of this section, and infusion pumps that are DME (including external ambulatory infusion pumps), but excluding all other DME and parenteral and enteral nutrients, equipment, and supplies (such as infusion pumps used for PEN)), that meet the following conditions:

(1) They are furnished personally by one of the following individuals:

(i) The referring physician.

(ii) A physician who is a member of the same group practice as the referring physician.

(iii) An individual who is supervised by the referring physician or, if the referring physician is in a group practice, by another physician in the group practice, provided that the supervision complies with all other applicable Medicare payment and coverage rules for the services.

 

Below is an excerpt from Starklaw.org regarding the in-office ancillary exception in §411.355 of the Stark legislation.

“May a group practice provide and bill for ancillary services provided in shared office space using shared equipment if the supervision requirement for the particular service is satisfied by a “member” of the group and the arrangement otherwise complies with Medicare coverage and reimbursement regulations?

Yes. Services that qualify for the in-office ancillary exception in §411.355(b) must satisfy performance, location, and billing requirements. In order to satisfy §411.355(b)(1), a service must be furnished personally by: (i) the referring physician, (ii) a physician who is a member of the same group practice as the referring physician; or (iii) an individual who is supervised by the referring physician or, if the referring physician is in a group practice, by another “physician in the group practice.” A “physician in the group practice” is defined at §411.351 to include both a “member” of the group practice as well as an independent contractor during the time the independent contractor is performing services in the group practice’s facilities. Assuming that the location and billing requirements in §411.355(b) are satisfied, in-office ancillary services supervised by a member of the group practice would not be subject to the referral prohibition.”

We hope you find the above references useful as you move forward with the addition of in-house ancillary services to your practice. We also hope that Pinnacle Mobile Imaging can be a part of your growth in the days to come. We would be happy to answer any questions you should have or provide physician references who can speak to our quality, timeliness, experience and professionalism.