Stark Law : The Self Referral Law

Our healthcare system is in a state of constant change. Just as the industry was adapting to the demands of countless healthcare reforms, the fate of regulations like the Affordable Care Act (ACA) and others like it, dangle in the wind. As the country transitions to a newly appointed administration, there is an increasing level of uncertainty among industry leaders. Federal, state, and local mandates continue to drive the need to improve the quality, costs, and outcomes of care which add to an already overburdened and burnout system. These coupled with our highly secular society who is primarily focused on the treating and curing illness through advanced technology, medications, and procedures has resulted in a

Medicare laws, regulations, and processes are ever changing. In order to comply with Medicare changes, HIM professionals must conform. HIM professionals play a critical

Laws like these are being implemented and changed widely across the United States to help ensure patients are receiving adequate care that they deserve.

The American Health Care system needs to be constantly improved to keep up with the demands of America’s health care system. In order for the American Health Care system to improve policies must be constantly reviewed. Congress still plays a powerful role in public policy making (Morone, Litman, & Robins, 2008). A health care policy is put in place to reach a desired health outcome, which may have a meaningful effect on people. People in position of authority advocates for a new policy for the group they have special interest in helping. The Health care system is formed by the health care policy making process (Abood, 2007). There are public, institutional, and business policies related to health care developed by hospitals, accrediting organizations, or managed care organizations (Abood, 2007). A policy is implemented to improve the health among people in the United States. Some policies

This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the Beneficiary Notices Initiative to alert the Medicare beneficiary prior to rendering the service. The Medicare beneficiary is notified via the Advance Beneficiary Notice (ABN) (see page 235 in Appendix B).

The current paper examines the Disproportionate Share Hospital Payment Reduction CMS 2367F rule which was effective on November 18, 2013. The Disproportionate Share Hospital Payment Reduction CMS 2367F is Federal Legislation that was implemented due to the Affordable Care Act. The rule was initially proposed by the Centers for Medicare & Medicaid Services (CMS), HHS on May 13, 2013. The proposed rule was to implement the provision of the Affordable Care Act that reduces Medicaid Disproportionate Share Hospital (DSH) allotments.

The terminology (i.e., Federal health care programs) contains any program that provides medical benefits, even if directly, by means of insurance, that is paid directly, in full or in part, by the US Government (i.e., Through programs such as Medicare, Federal Employees Health Benefits Act, Federal Employees’ Compensation Act, the Longshore and Harbor Worker’s Compensation Act) or any State health plan (e.g., Medicaid, or a program receiving funds from block grants for social service plan requirements. Guidelines, an industry should have

In 1989, Congress enacted the Ethics in Patient Referrals Act. Commonly known as Stark law, Congress named it in honor of Rep. Pete Stark, a Democrat from California, and original sponsor of the bill (Sprague 2004). This law places limitations on self-referrals by physicians and prohibits physicians from referring patients to organizations in which

Furthermore, Senate Bill 1216 provides direction to the Commission of Insurance for Texas to begin the development of the standardized form with input from an advisory committee and the centers for Medicare and Medicaid services (CMS). The

There are many private and public sectors of the health care system that go through an action or a process and these policies impact federal,

How have these laws and policies been used to control fraud, waste, and abuse in federal health care programs?

Laws are essential to healthcare because it helps protect anyone in healthcare. One of the laws is HIPPA known as Health Insurance Portability and Accountability Act, it is the most well-known medical law. This protects patients privacy about medical treatment and records. Not only this, but HIPPA goes beyond that protection, it also provides the ability to transfer and continue health insurance coverage when workers change or lose their jobs, reduces healthcare fraud and abuse, and mandates industry-wide standards for healthcare information on electric billing and other processes. The Stark law is one only those with the advanced understanding of healthcare administration and law may have heard of. Stark law is another way to safeguard against

The health care industry is one of the most dynamic and delicate industries in the U.S. having experienced healthy and substantial changes for the last thirty years most of which have aimed to improve health care management and services delivery to the patients. The changes have enabled the integration of technology into the industry such as in the area of informatics, science and research and payment services and clinical treatments. The health care sector has introduced various changes to address disease and health care management such as the Modernization Act of 2003, the Patient Protection Act and Affordable Act, which aim at improving health provision and most

Implementing all of these standards and policies within a company is certainly not an easy thing to do, and therefore it is imperative to understand whether or not your company will need it or not. In fact, it is easy to say that any company working within the federal healthcare system, whether it be insurance, practice, healthcare education, or many others, will need this sort of regulation used efficiency internally in order to prevent federal violations, which will be entirely detrimental to your reputation and ability to produce a

Starting 2016, CMS (Centers for Medicare and Medicaid Services) started covering advance care planning re-imbursement as a separate service. The final rule creates a separate Medicare billing code and provider reimbursement rate. If beneficiaries desire advance care planning during their annual wellness visit, physicians and other health professionals may provide it and bill Medicare separately. How Policy Impacts the Nursing Home Resident Policy impacts measurable outcomes – in this case, the life of the 101-year-old nursing home patient.