Anti-MarkUp and Under Arrangements:
Stark Beyond Stark

Teleconference
December 16, 2008

The Medicare Fee Schedule and Inpatient Prospective Payment System rules for 2009 both have changed some basic reimbursement rules for diagnostic testing payment amounts and whether services can be paid for and to whom when they are “under arrangements”. Both sets of rules create new challenges where physician groups either provide or obtain professional or technical components and pieces of all Medicare diagnostic testing of any type (anti-markup), as well as when they provide any kind of Stark DHS to another entity who bills for it (“under arrangements”). Rules which used to apply only to DHS now are even more restrictively applied to diagnostic testing relationships. Entities which provide non-DHS on their own become DHS entities when they are “under arrangements.” In this teleconference, Alice will elucidate:

• When the markup prohibition applies
• How to analyze whether Alternative 1 or 2 is yours
• The amount you can charge when the prohibition pertains
• The special rules for mobile diagnostic testing
• The restrictions on site of service
• The required degree of physician supervision
• Concepts which no longer matter
• How you can unbundle to avoid the prohibitions
• How rules first applied only to DHS now affect all diagnostic testing
• How “under arrangements”, which was a hospital-only reimbursement concept, now applies to all DHS
• Who is the DHS entity in “under arrangements” situations