Home > Regions > North America > Rick Hindmand and Liz Sullivan were featured in "Stark Law Disclosure Requirement for MRI, CT and PET Tests," published by RBMA

Rick Hindmand and Liz Sullivan were featured in "Stark Law Disclosure Requirement for MRI, CT and PET Tests," published by RBMA

Stark Law Disclosure Requirement for MRI, CT and PET Tests
By: Rick Hindmand and Liz Sullivan

As of January 1, 2011, physicians who furnish MRI, CT or PET services for their Medicare patients in reliance on the in-office ancillary services exception must inform the patient in writing at the time of the referral that the patient may obtain the MRI, CT or PET test from others. This disclosure requirement was enacted as part of the Patient Protection and Affordable Care Act. The notice to patients must be provided at the time of the referral and must include a list of at least five other “suppliers” within a 25 mile radius of the physician’s office.

The list of suppliers must include the names, addresses and telephone numbers of the other suppliers. Hospitals may be included in the notice, but are not considered a supplier. If less than five suppliers are located within the 25 mile radius, all suppliers in the area must be listed. Only suppliers capable of performing the applicable service may be included on the list. While the patient’s signature is not required, physicians are directed to document their compliance with the disclosure requirement in some manner. Written notice must be presented to the patient each time a CT, MRI or PET referral occurs, regardless of whether a prior disclosure was made to the same patient. If a referral is made by phone the written notice must still be provided and documented.

Physician practices should implement policies and procedures to ensure that the required patient notice accompanies each CT, MRI or PET referral of a Medicare patient if the test may be performed within the physician practice entity. Failure to provide notices when required could result in Stark Law violations with significant financial consequences, including civil monetary penalties of up to $15,000 per claim, refund obligations, and perhaps even false claims liability and exclusion.

To learn more about this requirement, visit: http://www.mcdonaldhopkins.com/alerts/alert.aspx?id=cEGdg6AyS0K00PZeBS0_Lw

Reprinted with permission from RBMA RadCast May 17, 2011 issue.

http://www.rbma.org/Products_and_Resources/Legal_Resources/RBMA_Monthly_Legal_Update_Digest_May_2011.aspx