2011 Proposed Medicare Fee Schedule Clarifies Stark Imaging Disclosure Requirements

In case you missed it, the Centers For Medicare and Medicaid Services (CMS) has published the CY2011 Proposed Medicare Physician Fee Schedule for public inspection.  The Proposed Fee Schedule includes a number of provisions which, if adopted, would implement the recently enacted Affordable Care Act (ACA).   One of the proposed regulations would serve to clarify the requirement in ACA that physicians notify patients referred for imaging services within the physician's practice of alternate imaging providers.

CMS has interpreted the ACA disclosure requirement to be effective only when the final rule is adopted.  If adopted in final, CMS would propose making the rule effective as of January 1, 2011.

The proposed rule includes the following clarifications:

1.  For the time being, the disclosure requirement would apply only to MRI, CT and PET, but CMS is asking for comments on whether the requirement should also apply to radiology and other imaging services;

2.  The disclosure notice should be written in a manner sufficient to be reasonably understood by all patients and must, as the ACA requires, be given to the patient at the time of the referral;

3.  Nothing on the disclosure notice or list of suppliers may indicate to the patient that he or she must receive imaging from a supplier on the list if not receiving the service from the referring
physician;

4.  The list can include on other "suppliers" of the services in question not including hospitals or critical access hospitals;

5.  The suppliers included in the notice should be located within a 25-mile radius of the physician’s office location at the time of the referral;

6.  The written notice must include no fewer than 10 other suppliers or all of the suppliers of the service within a 25-mile radius if there are fewer than 10;

7.  The list must include the name, address, phone number, and distance from the physician’s office location at the time of the referral;

8.  Finally, In order to document that this disclosure requirement has been satisfied, a record of the patient’s signature on the disclosure notification must be maintained as an element of the patient’s medical record.