Are you Following the Stark II Phase II Rules for Professional Courtesy?

While some of you may be aware of this, KZA finds many practices are unclear or unaware of these regulations. To offer professional courtesy to members of the medical community, practices must adhere to the following criteria:

• The professional courtesy is offered to all physicians on the entity's bona fide medical staff or in the entity’s local community without regard to the volume or value of referrals or other business generated between the parties.

• The health care items and service provided are of a type routinely provided by the entity.

• The entity's professional courtesy policy is set out in writing and approved in advance by the governing body of the health care provider.

• The professional courtesy is not offered to any physician (or immediate family members) who is a federal health care program beneficiary, unless there has been a good faith showing of financial need.

• If the professional courtesy involves any whole or partial waiver of any coinsurance obligation, the insurer is informed in writing of that reduction so that the insurer is aware of that arrangement.

• The professional courtesy arrangement does not violate the anti-kickback statute or any billing or claims submission laws or regulations.

Source: http://www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms1810ifc.pdf

For more information, work with your local healthcare attorney. To learn more about coding, best business practices and risk issues, sign up for a 2007 KZA Workshop near you.