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Disclosure Requirement When Referring for Diagnostic Imaging Services Where You Have a Financial Interest

Provided by: Jennifer Kirschenbaum, Esq.

April 19, 2011

Question:

Jennifer,

My group owns its own MRI. I heard something about a new disclosure requirement. Please comment.

Thanks, Dr. K

Answer:

Yes. In addition to existing NYS law requirements, under The Patient Protection and Affordable Care Act of 2010, the Stark law was modified to require practitioners to provide disclosure to patients when referring them for diagnostic imaging services (MRI, CT and PET) available where the provider has a financial interest. The New York self-referral statute requires similar disclosure requirements as well. In order to satisfy both statutes, disclosure must:

1. be in writing;

2. at the time of each referral;

3. state that the patient may obtain services for which the patient is being referred from a person other than the related entity;

4. provide the patient with a written list of at least 5 suppliers within 25 miles who furnish the same services in the area where the individual resides. Information for each alternative supplier must include: name, phone number, and address.

As with all of your other policies and procedures, if you would like assistance, do not hesitate to contact our office.

For those who may be interested in reading the actual statute, see the relevant provision below, codified at 42 CFR 411.355:

(7) Disclosure requirement for certain imaging services.

(i) With respect to magnetic resonance imaging, computed tomography, and positron emission tomography services identified as "radiology and certain other imaging services" on the List of CPT/HCPCS Codes, the referring physician must provide written notice to the patient at the time of the referral that the patient may receive the same services from a person other than one described in paragraph (b)(1) of this section. Except as set forth in paragraph (b)(7)(ii) of this section, the written notice must include a list of at least 5 other suppliers (as defined in � 400.202 of this chapter) that provide the services for which the individual is being referred and which are located within a 25-mile radius of the referring physician's office location at the time of the referral. The notice should be written in a manner sufficient to be reasonably understood by all patients and should include for each supplier on the list, at a minimum, the supplier's name, address, and telephone number.

(ii) If there are fewer than 5 other suppliers located within a 25-mile radius of the physician's office location at the time of the referral, the physician must list all of the other suppliers of the imaging service that are present within a 25-mile radius of the referring physician's office location. Provision of the written list of alternate suppliers will not be required if no other suppliers provide the services for which the individual is being referred within the 25-mile radius.

 

For additional information on this topic, contact Jennifer Kirschenbaum at (516)-747-6700 ext. 302 or at Jennifer@Kirschenbaumesq.com.

 

Copyright © 2011 by Kirschenbaum & Kirschenbaum, P.C.
All Rights Reserved. This email is provided for news and information purposes only and does not constitute legal advice or an invitation to an attorney-client relationship. While every effort has been made to ensure the accuracy of the information contained herein, Kirschenbaum & Kirschenbaum PC does not guarantee such accuracy and cannot be held liable for any errors in, any reliance upon this, or losses caused by the information. Under New York’s Code of Professional Responsibility, this material may constitute attorney advertising. Prior results do not guarantee a similar outcome.


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