CMS proposes rule on Stark Physician Imaging Notice

On Friday, June 25th, CMS announced its intentions with respect to the notice physicians are required by Section 6003 of PPACA to give to patients upon referral for an MRI, CT or PET service which the referring physician or group provides. These proposals give significant relief to Physicians and clarify the type of notice which will be considered compliant. First, and most significant, CMS proposes a January 1, 2011 , effective date rather than a retroactive effective date of January 1, 2010. This gives Physicians time to implement the notice without being in violation of the Stark law and facing refunds of bills for these services provided without notice from January 1, 2010. Second, while Section 6003 gives CMS the right to require the notice for designated health services other than MRI, CT, and PET, CMS indicates it is considering limiting the notice requirement to those services. Third, while the language in Section 6003 requires the notice to be to suppliers close to the patient's residence and does not limit the number of suppliers, CMS is proposing the notice be given to ten suppliers within twenty five miles of the physician's office not the patient's residence. If there are not ten suppliers within twenty five miles, CMS proposes the notice be to all providers within twenty five miles. The proposed rule also makes clear that CMS does not consider supplier to include hospitals. The notice must notify the patient of his or her right to obtain the services elsewhere, be given in writing at the time of the referral for the service, and include the name, address, phone number and distance from the physician's office of the other suppliers. The physician must document the notice by having the patient sign it and it must be made a part of the medical record.

The proposal was published as part of the Payment Policies Under the Physician Fee Schedule. The proposed rule will be published in the Federal Register on July 13th for comment and will not become final until after comments have been submitted and considered.

For more information, contact Janet Craig at [email protected] or (859) 226-2377.