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Can
I service my Medicare/Medicaid patients at an IDC facility?
Yes, with some limitations. You may provide any service that is
not considered a "designated health service" to your
Medicare and Medicaid patients via your IDC facility lease. This
would include Cardiac Cath, Nuclear Medicine, PET Scanning and
Pain Management procedures.
Should
you wish for your government patients to receive MRI, CT or Ultrasound
services, they can still receive these at your IDC facility, under
the care of a leasing radiologist who will provide and bill for
these services, rather than through your lease agreement.
Under
the IDC leaseback model, you may provide MRI, CT and Ultrasound
services to your non-government patients without violating Stark
and Anti-Kickback laws.
Will
I need to obtain a new Medicare provider number?
No. If you are leasing time for non-designated health services,
the IDC facility becomes an extension of your practice for your
scheduled period of time. Thus, you can bill and collect for diagnostic
services performed at IDC under your existing Medicare provider
number.
How
does the lease-back concept fit within Stark and Anti-Kickback
legislation?
IDC's unique lease-back concept complies fully with Stark legislation
under the "In-Office Ancillary Services," "Lease
Arrangements," and "Fair Market Value Compensation"
arrangements. Our model complies with Anti-Kickback legislation
under the "Management Services" and "Lease Arrangements"
Safe Harbors. The IDC Legal Review provides complete details as
outlined by healthcare legal experts Jenkens & Gilchrist PC;
their full legal opinion is also available for review.
What
is the compensation arrangement at IDC?
You pay IDC a set monthly lease rate for the facility, employees
and equipment, based on the annual number of hours contracted
for each modality. Contract time required is determined through
a rigorous analysis of your practice's current referral patterns
for diagnostic services, and is pre-set for the contract period
(in order to comply with regulatory requirements).
Through
this arrangement, the IDC facility is simply an extension of your
practice during your leased time. You bill and collect the technical
fee for each procedure performed (or, the global fee for procedures
performed by you or a physician with whom you subcontract).
Can I simply pay a fee per procedure and still
bill and collect for that procedure?
No. IDC maintains responsibility for offering a legally sound
product to our customers; a fee per procedure (or "per-click")
arrangement gives rise to several legal issues.
The
Stark and Medicare Anti-Kickback laws respectively prohibit a
physician from referring government patients to a facility in
which the physician has a financial interest and prohibit an exchange
of value between a physician for the referral of such patients
unless certain exception criteria are met. In other words, there
can be no relationship between physician remuneration and volume
of referrals.
According
to the OIG, percentage or per-use arrangements between health
care providers (i.e. imaging centers, hospitals, physicians) in
a position to refer Medicare or Medicaid business may violate
the Anti-Kickback statute, because the payments are directly tied
to the volume of business or amount of revenue generated, providing
an improper incentive to refer. Thus, these arrangements are subject
to heightened scrutiny and have been specifically addressed by
HCFA and OIG. A "per-click" arrangement also raises
scrutiny from the Stark perspective, since the relevant Stark
exception states that rental charges and fees must not be determined
in a manner that accounts for the volume or value of any referrals
or other business generated between the parties. A "per-click"
arrangement clearly links rental fees to volume of referrals.
An
existing imaging center in my market has proposed a similar lease-back
opportunity to me. Are there any issues I should be aware of?
Any
imaging center that is a 'provider' (i.e. bills and collects for
diagnostic imaging services under its own tax ID number), yet
also offers a lease-back model, is subject to legal scrutiny.
According
to Stark, a compensation arrangement between an imaging center
and a physician group prohibits the group from referring a Medicare
or Medicaid patient to that center, and prohibits the center from
billing to Medicare or Medicaid for that patient, unless specific
Stark exception criteria are met. Thus, in an imaging center that
is also a 'provider,' physicians cannot provide diagnostic services
to government patients under their lease-back arrangement. Furthermore,
even if no Medicare and Medicaid patients flow through the lease-back
arrangement, the lease-back arrangement is not protected under
Stark if government patient referrals are otherwise made between
the parties.
If an imaging center that is also a 'provider' is offering a "per-click"
arrangement to leasing physicians the arrangement is subject to
heightened legal scrutiny for the reasons addressed here as well
as those addressed in the "fee-per-procedure" discussion
(above).
Since
IDC will NEVER directly bill and collect for services provided
to ANY patient, we are not considered a 'provider' of health care
services and are not subject to provider-based restrictions. Thus,
the IDC model fits more soundly within the framework of current
regulations than any structure an existing, 'retail' imaging center
is able to offer.
What
authority will I have over IDC employees?
IDC employees specific to a given modality become your employees
during the time you lease that modality at IDC. During your leased
time you will have authority over these employees just as you
would in your primary office, and will share with other leasing
physicians in the overall responsibility for hiring, firing and
ongoing personnel management decisions. The day-to-day responsibility
is delegated to an on-site IDC manager on your behalf.
Am
I subject to a long-term agreement with IDC?
No. By law you must have at least a one-year lease, in order for
the arrangement to qualify for regulatory exemptions. However,
your profit potential with IDC is maximized through longer lease
terms (three to five years).
What
radiology arrangements will be made for my studies to be read?
Each IDC facility will arrange for a radiologist or radiology
group leasing time at the center, to provide clinical supervision
and reading services for procedures provided there. However, your
practice may choose to use the radiologist/group of your choice
to read your studies. Your practice makes these arrangements directly
with the radiologist/group, allowing you maximum control over
economics, process and turnaround. With certain modalities and
specialties (i.e. cardiologists and Nuclear Medicine, or Neurologists
and MRI), you may wish to read your own studies; this arrangement
is acceptable at IDC.
Do
I need to hold an NRC License in order to lease Nuclear Medicine
or PET Scan time at IDC?
No, it is not necessary for individual leasing physicians to be
licensed in nuclear medicine. The IDC facility must and will be
licensed. A designated safety officer must provide oversight to
ensure the center continually meets licensure requirements, and
typically performs quarterly audits. This safety officer is designated
by IDC and may be a leasing physician, a separately contracted
physician or a nuclear physicist. In addition, any physician reading
individual patient studies must be licensed in Nuclear Medicine.
However, as indicated in the "radiology" question above,
the leasing physician group may arrange with whomever they choose
to perform this function.
What
type of equipment will be available at IDC?
IDC centers will be furnished with state-of-the-art equipment
for all modalities, with upgrade capacity to accommodate technological
advances. In order to benefit from economies of scale and share
that benefit with leasing physicians, IDC will work nationally
with manufacturers to equip all centers across the country. These
vendors are chosen with input from clinicians in all specialties,
ensuring an effective balance between cost-effectiveness and clinical/operational
advantage.
How
will patients be scheduled in the center?
IDC offers two lease scheduling methods, depending on physician
preference for each modality contracted:
"Block" Time: your monthly lease time is scheduled
during specific hours and days of the week. Physicians typically
choose this option for modalities where they performs the service
personally (such as with various Cardiac procedures), or otherwise
prefer to be on-site at IDC during their leased time. In this
arrangement, the leasing physician practice will schedule patients
who are to be seen at the IDC site of service during their leased
time period; IDC will make reminder calls to those patients
the day before they are to be seen.
"Flex"
Time: your patients may be scheduled at any convenient time
during the week, much like they would at another imaging center.
The leasing practice will contact the scheduler at the IDC facility
to schedule all patients to be seen. The scheduled time will
be calculated on a quarterly basis according to the terms of
the IDC Sublease.
Do
I need to be in the IDC office when my patients are being seen?
Not usually, although a specific answer depends on the 'Incident
To' physician supervision requirements for the modality being
leased. For most modalities, 'Incident To' simply requires either
a physician member or agent of the leasing physician group be
on-site for the procedure, but not necessarily in the procedure
room. In some states, the member or agent can be a nurse practitioner
or physician's assistant. Leasing physician groups can arrange
this on their own, or IDC can facilitate a sub-contractual arrangement
with a physician or agent who will be on-site at the IDC location
at all times. At most IDC facilities, this supervision can be
provided by the radiology practice affiliated with the center.
Who
will do my billing for these procedures?
Since IDC is an extension of your practice, your office bills
and collects for all procedures performed in the IDC center. IDC
provides training and resources to make this as easy as possible
for your billing staff.
For
each patient seen, the technician performing the procedure will
complete a comprehensive Charge Capture Sheet indicating the specific
CPT codes for the procedure performed. At the end of each day
during which you have serviced scheduled patients, these sheets
will be faxed to your billing office, and information can simply
be input from the Charge Capture Sheet into your billing system.
How
will my primary office staff know how to work with the IDC office
staff?
Once a lease agreement is signed with your practice, IDC will
conduct an on-site orientation with your office staff, to review
all scheduling and billing procedures. Any person you designate
may attend, but it is highly recommended that your practice administrator
and nurse supervisor attend, and that you have representation
from your scheduling and billing staff.
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