PPAHA Amends Stark II; effective immediately Print
Written by Sandra Greenblatt   
Monday, 05 July 2010 16:16

Sandra Greenblatt, Esq.
Board Certified Health Law Attorney

We have heard a great deal about the Patient Protection and Affordable Healthcare Act ("PPAHA") being targeted at insurers, HMOs and employer and not being effective until 2014.  However, buried in PPAHA, Section 6003, on page 1564, is an amendment to the Stark II law targeting physician practices and effective immediately (actually 1/1/2010). 

PPAHA amends the Stark II law and requires physician practices which provide MRI, CT and PET under the in-office ancillary services exception to advise their Medicare patients in writing that  such services can be obtained from someone other than the practice of the physician ordering the procedure.  PPAHA also requires the referring physician to provide the patient with a written list of alternative suppliers who furnish such services in the area in which the patient resides (at least 2, not including hospitals). 

If your medical practice provides some other Stark law designated health service (DHS), these provisions may at some  future point also apply, as the Secretary of HHS is authorized under PPAHA to add to the list of covered DHS requiring patient notification.  This law now applies to your practice if you provide MRI, CT or PET services billable to Medicare.  We recommend that you have your patients sign something to indicate that you have given them notice of their choice of suppliers and keep this in the patients' records, in the event the government ever audits.  We understand that CMS may not seek to enforce this provision immediately, but that doesn't protect you against a whistleblower who might!

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Last Updated on Monday, 05 July 2010 17:12