Primarily based on current modifications and clarifications made by the Facilities for Medicare and Medicaid Providers (CMS) within the Federal Doctor Self-Referral Regulation (generally often known as the “Stark Regulation”), hospitals and well being programs have to revisit their doctor compensation plans. If the compensation falls below the in-office ancillary companies exception, then most of the modifications don’t have an effect on compliance with the Stark Regulation, but when the hospital or well being system seeks to satisfy the Stark Regulation employment exception and/or oblique compensation association exception, the association ought to be fastidiously reviewed.
Associate Jana Kolarik and PYA Principal Angie Caldwell, who tackle the valuation facets of the evaluation, printed two articles in Bloomberg Regulation that debate the next compliance takeaways intimately:
- Some doctor compensation plans have been set as much as set off evaluation when productiveness is above the 75th percentile. In December 2020, CMS made clear that there are not any presumptive percentiles which are FMV. Such compensation plans ought to be fine-tuned to make compensation per the doctor’s private productiveness, as an alternative of assuming that something under the 75th percentile will likely be deemed honest market worth (FMV).
- Concerning a business reasonableness (CR) evaluation, make sure the compensation is per the companies carried out by the person practitioner. For instance, if a doctor is compensated primarily based on his/her superior observe suppliers’ (APPs’) work relative worth models (wRVUs), be certain that such compensation is for companies carried out by the doctor, i.e., supervision. (For this dialogue, APPs embrace nurse practitioners and doctor assistants.)
- Evaluate present preparations that would fall below the definition of “oblique compensation preparations,” which was just lately revised, as a result of sure compensation preparations that take into account APP wRVUs as doctor compensation might have points assembly CR and FMV exams and the oblique compensation preparations exception below 42 C.F.R. § 411.357(p).
Jana will likely be discussing the Stark Regulation modifications, and Angie will likely be offering associated valuation examples throughout the September 13, 2022 Let’s Speak Compliance webinar entitled Stark Regulation Modifications and Affect on Doctor Compensation Half 2. Attendees might ask questions upfront. Please be a part of us on September 13th!
