CMS Announces Historic Changes to Physician Self-Referral Regulations

CMS Announces Historic Changes to Physician Self-Referral Regulations

Unprecedented additions to regulations that interpret Stark Law open avenues for health care providers to ensure that patients receive the highest quality of care.

Today the Centers for Medicare and Medicaid Services (CMS) finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the Stark Law, generally prohibits a physician from sending a patient, who needs many types of services, to a provider who the physician owns, is employed by, or otherwise receives payment from—regardless of what that payment is for. The old federal regulations that interpret and implement this law were designed for a health care system that reimburses providers on a fee-for-service basis, where the financial incentives are to deliver more services. However, the twenty-first century American health care system is increasingly moving toward financial arrangements that reward providers who are successful at keeping patients healthy and out of the hospital. This is an arrangement where payment is tied to value rather than volume.

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Please contact your RCPA policy staff for more information.

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