Once more, from the top: HCFA looks at MD referrals
Once more, from the top: HCFA looks at MD referrals
Agency wants to keep rules consistent with Stark
In a statement filed in the Federal Register, the Health Care Financing Administration (HCFA) says it will re-examine Medicare regulations pertaining to indirect compensation arrangements between home health agencies and physicians who "certify or recertify the need for home health services or establish or review the home health plan of care."
HCFA explains that it has withdrawn its recent interpretations regarding indirect compensation where the physicians are salaried employees or have a contractual arrangement to provide services for an entity that also owns the home health agency.
The interpretation freeze will allow HCFA to evaluate its recent interpretations of these regulations and related provisions of section 1877 of the Social Security Act to ensure consistent application of Medicare policy among providers of services, the agency says.
Thomas Hoyer, director of the chronic care purchasing group for HCFA in Baltimore, says that a problem arose with the interpretation of a clarification letter he wrote concerning indirect compensation arrangements where physicians are salaried employees of a hospital or an entity that owns a home health agency.
"One interpretation was if you were an intern at the hospital and writing a plan of care for a home health agency owned by the hospital, your relationship was indirect compensation if you were paid by the hospital $25,000 or more," Hoyer explains. "But why shouldn’t an employee of a hospital write a plan of care for his employer?"
The policy was further clouded by the Stark regulations, Hoyer says, which "has provisions to exclude a bona fide employee of a rural hospital." Often in rural communities, the hospital and its home care agency are the only providers, and the Stark regulation makes allowances for that.
"Our plan," says Hoyer, "had been to make this [rule] consistent with Stark."
HCFA says it therefore has withdrawn recent interpretations of the indirect compensation under Sec. 424.22(d) and plans to publish a new rule in the Federal Register "in the very near future."
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