The in-office ancillary services exemption is under attack again, according to a report from Mondaq.
The Department of Health and Human Services hinted at limiting the in-office ancillary services exemption in the Fiscal Year 2016 proposed budget. The changes if adapted would dramatically harm private practice and lead to a great deal of acceleration in hospital employment.
Here are five things to know:
1. Physicians are currently able to refer patients to some in-office services, including diagnostic imaging, physician therapy, clinical labs, radiation therapy and supplies under a Stark Law exemption if they adhere to strict guidelines. These guidelines allow a practice to provide the services in their offices if they meet a location, billing, group practice and other tests.
2. Opponents say the in-office ancillary services exemption has caused over-utilization and rapid growth in these services. Ie, that the original purpose of the exception was for doctor and patient convenience and quick turnaround to enhance treatment and that it is now used as a huge money maker and differently than intended.
3. HHS argues in the budget proposal that some of these services are rarely provided on the same day as the physician office visit. Ie, they are provided in a manner different than intended.
4. HHS proposed eliminating self-referrals for therapy, advanced imaging, radiation therapy and anatomic pathology services unless they are at "clinically integrated" practices for cost containment. This change would dramatically harm private practices as many rely on their ancillary income to stave off becoming hospital employees.
5. These changes could save $6 billion over a decade, according to the report.