Hospital-Employed Non-Physician Practitioners and Community Physicians: Billing and Stark Law Considerations
- August 02, 2022
- Sven Collins , Hooper, Lundy & Bookman, PC
- Amy Joseph , Hooper, Lundy & Bookman, PC
- Charles B. Oppenheim , Hooper Lundy & Bookman PC
ABSTRACT: Hospitals nationwide are increasingly employing nurse practitioners and physician assistants—often called “non-physician practitioners” or NPPs—to help improve the quality, timeliness, and cost-efficiency of inpatient care, and to facilitate patient throughput. This trend, however, may also give rise to potential billing and Stark law compliance issues where non-hospital employed community physicians bill Medicare for inpatient care that inappropriately “piggybacks” on care provided by the hospital-employed NPPs. Depending on the circumstances, these arrangements could be viewed as physicians misrepresenting their services to Medicare (potentially facilitated by the hospital) and/or the hospital providing free services to the physicians in violation of the Stark law.
In addition, significant recent changes to the “split (or shared)” billing rules further impact the analysis. These regulatory developments may present an opportune time to take a fresh look at potential issues where hospital-employed NPPs and community physicians provide overlapping care and to revisit existing policies for continued compliance. This article outlines the relevant legal issues and developments and offers some practical tips to limit the compliance risks these increasingly common arrangements present.
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