Page 42 - inmotion-21-05-web

This is a SEO version of inmotion-21-05-web. Click here to view full version

« Previous Page Table of Contents Next Page »

42 in Motion Volume 21, Issue 5 September/October 2011

One of those exceptions is for “in-offce ancillary services,” which has three elements: the frst relates to where the prosthetic services are provided; the second relates to

who provides them; and the third sets forth requirements for appropriately billing those items. As long as a doctor provides prosthet-ics to a patient consistent with the require-ments of the in-offce ancillary services exception, the doctor has not committed any Stark Law violation.

MyDoctor RefersMe to His or Her Facility: IsThis a GoodThing?

Now that you know that a physician can legally refer you to a prosthetist who works for him or her at a facility the physician owns*, where does that leave you? Simply knowing that a particular practice is legal doesn’t mean that your analysis as an informed patient should stop. This leads us to the more important question: How does the doctor’s right to send you to his or her own prosthetic facility help or hinder your prosthetic care and treatment?

The answer, like so many things in life, is “It depends.” From a purely mechanical per-spective, receiving treatment at a prosthetic facility owned by a doctor is no different than receiving treatment at a facility owned by businessmen or by prosthetists.

In both instances, the prosthetists need to be certifed. (In 13 states, they must also have a state license.) In both instances, the business has to apply to a Medicare-contracted entity (the National Supplier Clearinghouse) to obtain a National Provider Identifer number that permits it to bill Medicare andMedicaid. In both instances, the business has to

successfully complete an accreditation process mandated by Medicare. Simply put, if you walked into a prosthetic facility owned by your physician, you really couldn’t tell the difference between that on the one hand, and a practice that wasn’t doctor-owned on the other.

But – and this is the important point – just because your doctor has an ownership interest in a prosthetic facility doesn’t mean that the quality of care you receive there is demonstrably better (or worse) than care provided at an independent facility. The skill of the prosthetist and the rest of the pros-thetist’s team will determine whether you receive a well-ftting prosthesis.

So the equation is fairly simple: If your doctor has a quality prosthetist working for him or her, that might be an excellent place to go to receive your care; if the prosthetist is less skilled, your results will refect that as well. In the end, the issue with a doctor referring you to his or her facility isn’t that there’s some sort of objective evidence that care provided there is better or worse than care provided at an independent facility; it’s the fact that the doctor’s referral carries so much weight. As I’ve written about before in a slightly different context, such a referral

Now that you know that a physician can legally refer you to a prosthe-tist who works for him or her at a facility the physician owns, where does that leave you?

*Again, to be clear – the arrangement is legal as long as the doctor sets it up in strict compliance with the “ancillary services” exception in the Stark Law.

Page 42 - inmotion-21-05-web

This is a SEO version of inmotion-21-05-web. Click here to view full version

« Previous Page Table of Contents Next Page »