SDRP or Self-Referral Disclosure Protocol is a component of new-age Healthcare Reform that sets limits on physician referrals within a category of services known as DHS or Designated Health Services. Use of resources that fall within this realm (lab services, therapies, medical supplies, at-home services and prescription drugs) is explicitly limited in terms of Medicare billing. Expressly stated as limitations for physicians referring business to any entity in which they hold a financial stake, these restrictions are so strict, in fact, that a non-compliance or accidental overpayment from Medicare could lead a physician's office to accusations of fraud and top dollar claim repayments. So how do medical professionals best avoid this hurdle? By being absolutely certain their medical billing is Stark Law Compliant:
According to The US Department of Health and Human Services, Stark Laws (section 1887 of the Social Security Act) include:
- Prohibitions from making referrals to DHS facilities they (or a family member) have a financial stake in if the bill is made payable to Medicare.
- Designated Health Services (DHS) include: clinical laboratory services; physical therapy services; occupational therapy services; outpatient speech-language pathology services; radiology and certain other imaging services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients; equipment and supplies, prosthetics; orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services.
While some exceptions can be made for (a limited number of) financial relationships that can be proven to not possess a potential for patient abuse, things as simple as Physician Employment agreements, Medical Directorship agreements, On Call Agreements, and even logistical basics like Office Space Rental have the potential to raise questions with office compliance. For these reasons, Healthcare Networks of America urges physicians to review hospital policies and revisit terms of Stark Compliance before an accidental oversight become a costly problem.
Healthcare Networks of America (HNA) , established in 1993, is a national healthcare provider network consisting of over 20,000 providers in all 50 states.
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About the Author
Welcome to our PhysicianTrends Blog. We're here to talk about physicians and how they are changing in the midst of the most massive transformation in our healthcare system since Medicare. Whatever the outcome of healthcare reform legislation, it will not be "business as usual" for physicians. Physicians will get hit with the triple whammy…Fees will be going down (the deal between the AMA and Obama won't save you), overhead will go up (more regulation) and your taxes will escalate (how else do you pay for 45 million new insureds?) We'll give you our opinion, but then we want to hear from you…what are you doing to get ready for the change? We hope our blog will be a great resource to learn and share about the future practice of healthcare. visit http://www.physiciantrends.com
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