State and Federal Prohibitions on Physician Referrals


Book Description

Federal and state law restrictions on financial relationships between health care providers have undergone significant growth in the past decade. As the health care industry consolidates to form managed care systems and networks of providers, the financial relationship between providers becomes crucial in determining what referrals, marketing strategies, and billing practices are permissible. Defining the boundaries of permissible conduct under a myriad of statutes at both the federal and state level has become a difficult undertaking. This manual offers a variety of tools to assist attorneys and providers in understanding the complexities of the so-called Stark laws and regulations as well and presents a comprehensive state-by-state review of referral laws. Definitions, hypothetical case studies, full text of laws, regulations, and advisory opinions, corporate compliance polices relating to physician referrals, and checklists for determining the legality of specific financial arrangements make this an invaluable resource.




Federal Self-referral Law


Book Description

This portfolio examines in detail the federal statute commonly referred to as the Stark law, which places significant restraints on referrals of patients for Medicare-covered designated health services to an entity with which the referring physician (or a member of the physician's immediate family) has a financial relationship. The portfolio analyzes the complex definitions, numerous statutory and regulatory exceptions, and limits on applicability that complicate this statute's seemingly simple prohibition, emphasizing both formal and informal regulatory interpretations as well as the statutory language.




Improving the Quality of Health Care for Mental and Substance-Use Conditions


Book Description

Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.










Physician Self-referral


Book Description




The Stark Law


Book Description

Stark Law, Second Edition: A User's Guide to Achieving Compliance Penalties for violations can include $15,000 per claim--and you can be fined for even unintentional violations. Further consequences involve potential exclusion from participation in Medicare, Medicaid, and other federal health care programs.It's tough to simplify a complex rule. Here's help. You will be well equipped to protect your organization from the severe consequences of Stark Law violations with the practical analytical tools and explanations provided in "Stark Law: A User's Guide to Achieving Compliance, Second Edition. " This updated version of HCPro's Stark Law best seller, first published in 2005--and now co-authored by former CMS Stark Law regulator, Lisa Ohrin--helps health care providers, practitioners, suppliers, and other affected members of the health care industry understand the many recent changes in the Stark Law. It explains each provision of the rule and its practical effect for compliance professionals.There are no compliance shortcuts Since issuing its long-awaited Stark II, Phase III Regulations, CMS proposed and finalized a host of additional regulations, notices, and clarifications, including a major final rulemaking in August 2008. The number and speed of these changes add yet another layer to the already complex web of rules and regulations governing Stark Law compliance. Your copy of "Stark Law: A User's Guide to Achieving Compliance, Second Edition, " delivers: A thorough explanation of how the 2007 and 2008 regulations impact the Law as a whole, as well as your organization Access to a comprehensive outline of the entire Law in one location, from the initial proposed regulations through the most recent updates Scores of easy-to-understand case studies, which illustrate the application of the Law A searchable CD-ROM to help you find specific citations Take a look at the Table of Contents: Chapter 1: Background and Analytical Framework Chapter 2: Definitions Chapter 3: Designated Health Services Chapter 4: Referrals Chapter 5: Financial Relationships Chapter 6: All-Purpose Exceptions Chapter 7: Ownership Interest Exceptions Chapter 8: Direct Compensation Exception Chapter 9: Indirect Compensation Arrangements Exception Chapter 10: Exceptions for Physician Recruitment and Retention Payments in Underserved Areas Chapter 11: Period of Disallowance, Temporary Noncompliance, and Technical Noncompliance Chapter 12: Sanctions, Collateral Consequences, and Reporting Requirements Chapter 13: Advisory Opinions With such high stakes, your organization needs "Stark Law: A User's Guide to Achieving Compliance, Second Edition, " to remain on top of the recent amendments to the Law.