Thursday, February 22, 2024
HomeHealth LawCMS Streamlines Stark Regulation Self-Referral Disclosure Protocol (SRDP)

CMS Streamlines Stark Regulation Self-Referral Disclosure Protocol (SRDP)

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Efficient March 1st, sure suppliers selecting to self-disclose Stark Regulation violations should use varieties up to date by the Facilities for Medicare & Medicaid Providers (“CMS”).

Stark Regulation – Overview

The Stark Regulation prohibits a doctor from referring a Medicare beneficiary for designated well being providers to an entity with which the doctor (or the doctor’s rapid member of the family) has a monetary relationship, until an exception applies. See 42 U.S.C. § 1395nn. Suppliers who’re conscious that they’ve violated the Stark Regulation at any level inside the newest six-year interval might self-report violations in accordance with CMS’s self-referral disclosure protocol (“SRDP”). See 42 C.F.R. § 1003.140; 42 C.F.R. § 401.305(f). As soon as CMS acknowledges receipt of a supplier’s SRDP submission, the supplier’s obligation to report and return overpayments inside 60 days is suspended. See id. at § 401.305(b)(2)(ii).

New/Revised SRDP Types

CMS has revised sure SRDP varieties to streamline elements of the self-disclosure course of.

1. Group Follow Info Kind – New. CMS has developed a brand new Group Follow Info Kind that allows a bunch observe, as a complete, to establish which components of the group observe definitional necessities underneath 42 C.F.R. § 411.352 it did not fulfill. (The exception for in-office ancillary providers doesn’t apply to DHS referred inside and carried out by a doctor observe that doesn’t absolutely fulfill the Stark Regulation’s definition of a ‘group observe’.) The shape additionally requires the submission of an Excel spreadsheet that features the next data for every doctor who made prohibited referrals in the course of the relevant lookback interval:

  • Identify and NPI
  • Assertion of whether or not the referring doctor is an proprietor, worker, or unbiased contractor of the observe
  • Assertion of whether or not the referring doctor acquired compensation that did not adjust to the group observe necessities underneath the Stark Regulation
  • Interval of non-compliance

Use of this single kind replaces the prior requirement that every doctor of the observe submit a separate Doctor Info Kind. Nevertheless, the Group Follow Info Kind shouldn’t be used when a observe satisfies all group observe definitional necessities, however its DHS fails to satisfy the necessities of an exception codified at 42 C.F.R. § 411.355 (together with the exception for doctor providers at § 411.355(a) and the exception for in-office ancillary providers at § 411.355(b)). In such instances, separate Doctor Info Types must be accomplished and submitted for every referring doctor, per historic observe.

2. Doctor Info Kind – Revised. If an association doesn’t fulfill a Stark Regulation exception and the referring physicians stand within the sneakers of their doctor group (per 42 C.F.R. §§ 411.354(c)(1) or 411.354(c)(2)), then in lieu of submitting a Doctor Info Kind for every such doctor, a single Doctor Info Kind could also be submitted as long as it incorporates a separate itemizing of (i) the names and NPIs of every ‘shoe-standing’ doctor, i.e., of every doctor deemed to have the identical non-compliant compensation association with the DHS entity as his or her doctor group, (ii) the interval(s) of non-compliance for every such doctor, and (iii) different related data (e.g., if one of many physicians redeemed her fairness within the doctor group on a sure date, terminating her ‘shoe-standing’ standing as of such date).

3. Signed Certification – Revised. The signed certification might now be submitted electronically with out the necessity to mail a separate arduous copy of the signed certification to CMS. Due to this fact, all paperwork in reference to the SRDP might be submitted electronically by electronic mail to 1877SRDP@cms.hhs.gov.

In sum, sure elements of the SRDP course of are extra streamlined by enabling doctor practices to submit a single kind in lieu of a number of and almost equivalent varieties, and by allowing digital submissions and not using a arduous copy mailed individually.

Our workforce members can help with the SRDP course of by detangling its necessities and by stopping the submission of superfluous paperwork to CMS. When you have any questions in regards to the SRDP course of or latest adjustments to the SRDP’s required varieties, please contact any member of our Well being Care Staff for help.

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