PPACA and the In-Office Ancillary Exception Revisited

December 22, 2010, 9:52 AM

Updating a previous blog entry dated October 15, 2010, Centers for Medicare and Medicaid Services (CMS) has published its final rule on November 29, 2010, to implement the requirements of the Patient Protection and Affordable Care Act (PPACA) regarding disclosure of alternate providers of MRI, CT and PET diagnostic imaging procedures when referring a patient for such procedures pursuant to the Stark Laws in-office ancillary services exception.

The final rule retains the January 1, 2011 effective date set forth in the proposed rule, but there are a few significant differences between CMS proposed rule and the final rule. Among the notable and most significant changes is the reduction in the number of alternate providers that must be disclosed to the patient when referring the patient pursuant to the in-office ancillary exception for MRI, CT or PET procedures. The proposed rule would have required each such provider to supply the patient with a list of ten (10) alternate providers of the diagnostic services. The final rule has reduced the number of alternative providers that must be disclosed to the patient to five (5) such alternative providers.

In addition, the final rule has eliminated the requirement that the provider list the distance from the providers office to such alternative providers offices. Finally, the requirement that the patient actually sign the notice and the provider keep a copy of the signed notice in the patients file has also been eliminated, provided that the final rule does require that the provider document the fact that such notice has been provided to the patient. One such method of documentation would be to obtain the patients signature and retain that in the file, but CMS has also suggested that a provider may comply by noting in the patients record that the notice has been provided.

Thus, effective January 1, 2011, providers who are subject to the this rule, will need to provide patients with a list of five (5) alternate providers of MRI, CT and PET services which are located within a twenty-five (25) mile radius of the providers office location. The disclosure must include at minimum the alternative providers names, addresses and phone numbers. If there are less than five (5) alternate providers within a twenty-five (25) mile radius, then all such alternative providers within the radius must be disclosed, but if there are no alternative providers within the radius, the no such written list must be disclosed to the patient. -Aaron J. Ambrose