CMS Seeks Feedback on the Referral Relationships Between Therapists and Physicians
Recently, in its proposed rule governing the Medicare Physician Fee Schedule for 2008, the Centers for Medicare and Medicaid Services (CMS) announced that it is seeking comments on the referral relationships between physicians and occupational therapists (as well as other providers of designated health services). See 73 Fed. Reg. 38122, 38181 (Proposed Medicare Physician Fee Schedule for 2008).
CMS is considering whether to make changes to a number of exceptions to the Stark regulations, which prohibit physician self-referrals in order to curb Medicare fraud and abuse. AOTA urges occupational therapists who rely on physician referrals for outpatient services to share feedback on these issues with AOTA and with CMS.
The Stark Law prohibits a physician from making a referral to an entity for the furnishing of designated health services (DHS) if the physician (or an immediate family member) has a financial relationship with the entity, unless one of several exceptions applies.
Occupational therapy and physical therapy services are considered DHS under the Stark provision. When the referring physician has a financial relationship with the occupational therapist, many types of arrangements between an occupational therapist and physician may implicate Stark.
However, many of these same relationships are structured to fall under the current protection of the "in-office ancillary services" exception to Stark. CMS is concerned that the in-office ancillary services exception: (a) encourages physicians to create physical and occupational therapy practices, and (b) enables physicians to order and then subsequently perform ancillary services instead of making a referral to a specialist such as an occupational therapist.
CMS is soliciting comments on the following specific questions:
- Are changes to the in-office ancillary exception necessary, and if so, what changes should be made?
- Should occupational therapy services qualify for the in-office ancillary exception?
- Should occupational therapy services that are not provided on an incident-to basis qualify for the exception?
- Should services that are not needed at the time of the office visit in order to assist the physician in his or her diagnosis or plan of care qualify for the exception?
- Are there any other restrictions on the ownership or investment in DHS that would curtail Medicare program or patient abuse?
AOTA seeks member feedback on how to address these questions in formal comments to CMS. Share your thoughts with AOTA via e-mail to firstname.lastname@example.org by August 15 for inclusion in AOTA's official comments on the Proposed Medicare Physician Fee Schedule for 2008.
Occupational therapists can also submit comments directly to CMS no later than 5 p.m. August 31, 2007, by writing CMS and referencing file code "CMS-1385-P" in any one of the following four ways:
- Electronic Submission: Submit electronic comments on specific issues in the Medicare Physician Fee Schedule Proposed Rule for 2008 at http://www.cms.hhs.gov/eRulemaking.
- Regular Mail: Mail one original and two copies of written comments to: Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attention: CMS-1385-P, PO Box 8018, Baltimore, Maryland 21244-8018.
- Express or Overnight Mail: Send one original and two copies of written comments to: Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attention: CMS-1385-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
- By Hand or Courier: Deliver to one of two of the following addresses: deliver one original and two copies of written comments to either (a) 7500 Security Boulevard, Baltimore, Maryland 21244-1850 or (b) Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201.