Practice Management Alert

How does your understanding of these regulations compare to an expert’s?

1. True. “Stark starts with this basic prohibition: that if a physician or family member of a physician has a financial relationship with an entity, then that physician cannot refer a designated health service to an entity if that designated health service is going to be reimbursed by Medicare or Medicaid,” explained Stacy Nicole Harper, JD, MHSA, CPC, partner at Spencer Fane LLP in Overland, Kansas, in a presentation on Kickback Expansion during HEALTHCON 2020. “As a strict liability statute, that’s an absolute prohibition unless you meet one the exceptions … if you don’t meet all the requirements of an exception, then you have violated the law, whether you meant to or not.”

2. D. Stark only applies to physicians, but physician is also defined as including dentist, podiatrist, optometrist, and chiropractor specialty credentials, Harper said. However, Stark Law does not apply to nurse practitioners (NPs) or physician assistants (PAs). “Knowing the licensure of the people involved can have an impact on whether or not we have to deal with Stark,” Harper said.

3. A. Stark Law considers husband/wife, birth or adoptive parent, child, or sibling; in-laws (father, mother, son, daughter, brother, sister); grandparent or grandchild and spouse of grandparent or grandchild to be immediate family.

4. Under Stark Law, there’s a much broader definition of referral; it is not just explicitly steering a patient toward a particular facility. In fact, making a recommendation or steering a patient to a particular entity is only one component of making a referral under Stark Law, Harper explained. “Under Stark, just doing the order for the service itself is a referral.”

5. B. “Stark is really looking at your ancillary services: your labs, your imaging, your home health, your therapies, and then anything that happens in a hospital — inpatient or outpatient hospital services,” she said.

6. False. Stark and Anti-Kickback kind of cover the same topic of financial relationships in healthcare, but the two are actually very different in how they apply, Harper said. “Anti-kickback is a criminal statute, it’s intent-based, and it’s much broader in its application,” she said.

7. True. Anybody, including the patient, can be implicated or involved under the Anti-Kickback Statute, if the rest of the threshold is met: renumeration; referral, purchase, recommendation; item or service; involving a service that would be reimbursed by a federal healthcare program.

8. D. The federal healthcare programs that are implicated under the Anti-Kickback Statute include Medicare, Medicaid, Medicare Advantage, Tricare, and the programs for federal employees and mail handlers as well.

Resource: For more coding and practice management learning and networking opportunities, like HEALTHCON, consider attending an AAPC regional conference: www.aapc.com/medical-coding-education/conferences/.