COMPLIANCE ALERT- MAY 2011 |
SDRP or Self-Referral Disclosure Protocol is a component of new-age Healthcare Reform that sets limits on physician referrals within a category of services known as DHS or Designated Health Services. Use of resources that fall within this realm (lab services, therapies, medical supplies, at-home services and prescription drugs) is explicitly limited in terms of Medicare billing. Expressly stated as limitations for physicians referring business to any entity in which they hold a financial stake, these restrictions are so strict, in fact, that a non-compliance or accidental overpayment from Medicare could lead a physician’s office to accusations of fraud and top dollar claim repayments. So how do medical professionals best avoid this hurdle? By being absolutely certain their medical billing is Stark Law Compliant:
According to The US Department of Health and Human Services, Stark Laws (section 1887 of the Social Security Act) include:
- Prohibitions from making referrals to DHS facilities they (or a family member) have a financial stake in if the bill is made payable to Medicare.
- Designated Health Services (DHS) include: clinical laboratory services; physical therapy services; occupational therapy services; outpatient speech-language pathology services; radiology and certain other imaging services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients; equipment and supplies, prosthetics; orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services.
While some exceptions can be made for (a limited number of) financial relationships that can be proven to not possess a potential for patient abuse, things as simple as Physician Employment agreements, Medical Directorship agreements, On Call Agreements, and even logistical basics like Office Space Rental have the potential to raise questions with office compliance. For these reasons, Healthcare Networks of America urges physicians to review hospital policies and revisit terms of Stark Compliance before an accidental oversight become a costly problem.
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