Technical revenues, incident to, and Stark


Keep in mind there is an "incident to" aspect of the Stark in office ancillary services exception, the exception that applies to the technical component. As I understand it, if the technical service is "incident to" the physician's professional service, then it can be included in the physician's personal productivity part of the formula. If the technical service is not "incident to" the physician's professional service, then it must be included in the Designated Health Services earnings that are distributed in a manner which does not take into account the volume or value of the physicians' referrals. In distinguishing between technical services that are "incident to" a physician's professional service and ones that are not, one must navigate the "supervision" requirements.

Stark generally defers to the Medicare billing rules on the level of supervision required, although it does specify that the physician(s) who must supply the appropriate level of supervision for billing must be either the physician who orders the test or another physician in the same group practice. The levels of supervision required by the billing rules are something I have to revisit each time I'm faced with this issue for a client. My head is beginning to hurt just laying this much out, and I'm doing it primarily to hear from others on your thoughts on this subject.

The soundest advice I can give is that if you want to give direct credit to any physician for technical revenues, you might want to retain legal counsel experienced in the Stark law as it applies to physician practices to ensure that whatever compensation formulas/methods you devise will be Stark compliant.

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