• Change Ahead for Stark In-Office Ancillary Services Exception?
  • August 21, 2009 | Author: Donna S. Clark
  • Law Firm: Baker & Hostetler LLP - Houston Office
  • The Stark Law prohibits physicians from referring Medicare and Medicaid patients to entities with which they have a financial relationship for certain designated health services unless the relationship qualifies for an exception. Physician groups routinely utilize the in-office ancillary services exception to protect referrals for ancillary services furnished by the group. In commentary contained within the various preambles to the Stark regulations, CMS has noted the proliferation of advanced diagnostic technology within physician offices and solicited comments on revision of the in-office ancillary services exception. A bill recently introduced in the House appears to be the first effort to revise the exception.

    The bill, introduced by Rep. Jackie Speier (D-Calif.), and titled the “Integrity in Medicare Advanced Diagnostic Imaging Act of 2009” (H.R. 2962), would amend the exception to eliminate MRI, CT-scanning, and PET-scanning services from the scope of imaging services subject to protection under the exception. The bill also furnishes the Secretary of HHS with the authority to eliminate additional diagnostic imaging services in consultation with physician groups, but excepts certain imaging services, such as x-ray and ultrasound, from potential elimination. If enacted, physicians would be unable to furnish MRI, CT-scanning, and PET-scanning services to their Medicare and Medicaid patients.

    Recent studies conducted by the government cite a prolific rise in the use of advanced diagnostic testing at significantly increasing costs. In light of the search for savings to cover the cost of health reform, the concept of narrowing the in-office ancillary services exception may gain momentum.