A Reminder About Additional Disclosure Requirements For Physicians Practices Providing Certain Imaging Services
Physician practices that refer Medicare patients for in-office magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET) should be aware of changes to Stark law that require certain disclosure requirements.
Generally, the Stark law prohibits physicians from referring Medicare patients for certain designated health services (DHS) to any entity with which the referring physician, or his or her immediate family members, has any direct or indirect financial relationship. It also prohibits an entity from presenting or causing to be presented a bill or claim to anyone for DHS furnished as a result of a prohibited referral.
There is an exception, however, for in-office ancillary services (IOAS) if certain criteria are met. These include criteria related to supervisory, location, and billing requirements. Section 6003 of the Patient Protection and Affordable Care Act (PPACA) adds two new requirements in order to qualify for the IOAS exception with respect to MRI, CT, PET, or other radiology services provided to Medicare patients. At the time of the referral, the referring physician must: (1) provide the patient with written notice that the patient may receive the services from a Medicare supplier other than the referring physician or the referring physician’s group practice, and (2) provide the patient with a written list of suppliers who furnish the service in the area in which the patient resides.
The written notice must:
- Include a list of at least five other Medicare suppliers that are located within a 25-mile radius of the referring physician’s office. “Suppliers” includes physicians but not hospitals, which are Medicare providers. If fewer than five suppliers are located within the 25-mile radius, then all suppliers within this area should be listed. However, if no other suppliers provide the services for which the patient is being referred within the 25-mile radius, then the physician must only inform the patient that he or she may obtain services from another supplier, but need not provide a list of alternatives.
- Be reasonably understandable to all patients and include, at a minimum, the names, addresses, and telephone numbers for each alternative supplier on the list.
- Be presented to the patient each time a MRI, CT, or PET referral occurs, even if prior disclosures have been made to the same patient.
Although there is no provision that requires a signed disclosure by the patient or that the physician place the disclosure in the patient’s medical record, physicians must be able to document his or her compliance. As such and as a matter of prudent business practice, the physician should indicate in the patient’s medical record that such disclosure was made.