POP Definitions Flashcards
what is self-referral/referral for profit?
what are physician owned PT services?
financial gain (ownership, investment or a structured compensation agreement) for services which are not performed by the physician
physical owned PT services: (POPTS) same as above but specifically for PT
what is Stark Law?
ethical patient referral act (AKA Stark law I)
1990
physician cannot refer patients with Medicare coverage for profit to clinical labs
what is Stark Law II?
1993
Addendum added to the original Stark Law to include a list of other Designated Health Services that physicians could not acquire financial benefit.
This law involved patients with Medicare and Medicaid
what are the 11 health services listed specifically in Stark Law?
1- clinical lab services
2- PT services
3- OT services
4- radiology services (including dx nuclear med services and supplies, 14 MRI, CT scans, and US, but excludes nuclear medicine and certain radiology and imaging procedures requiring the insertion of a needle, catheter, tube or probe)
5- radiation therapy services and supplies ( including therapeutic nuclear medicine services and supplies)
6- durable medical equipment and supplies
7- parenteral and enteral nutrients, equipment and supplies
8- prosthetic, orthotics
9- home health services
10- outpatient prescription drugs
11- inpatient and outpatient hospital services
what are in office ancillary services?
(IOAS)
items from the DHS list that are part of the Stark Law, but considered in office services that can be reffered to and profited from because it is more convenient and appropriate for their health than referring out.
The list includes:
- radiology
- Dx imaging (MRI, CT, etc)
- clinical labs
- Outpatient services (PT, OT)
the growth of POPTS started to decrease for fear of fines and penalties until 2001 when..?
DHS changed to a shorter list of IOAS for patent convenience exceptions.
Three requirements must be met to apply related to the supervision, location and billing system.
This loop hole rendered the original Stark Law useless in regard to these services
What is the Promoting Integrity in Medicare Act?
PIMA 2013
exclude PT from in office ancillary services
IOAS were initially thought to be more convenient for pt’s b/c they were to be done on-site and on the same day of an office visit.
% of services that are utilized on the same day of physician visits:
10% CT and MRI
3% PT : 9% w/in 7 days; 14% w/in 14 days
