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Stark Law, anti-kickback updates may boost value-based payments

10 Oct 2019 10:28 AM | AIMHI Admin (Administrator)

Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

This is encouraging news for those who have quietly questioned whether the arrangements where hospitals, physician groups, hospice and home health agencies are paying EMS to provide care coordination for their patients could be construed as running afoul of the Stark Law.

Although these proposed rules apply to non-EMS agencies, it may signal the intent of the OIG.

Recall that JEMS published an article Steve Wirth penned on this issue in March 2019 - https://www.jems.com/articles/2019/03/recent-federal-advisory-opinion-favors-community-paramedic-programs.html

Stark Law, anti-kickback updates may boost value-based payments

October 09, 2019


HHS on Wednesday unveiled its long-awaited proposal to change its anti-kickback and self-referral laws, a move that was largely well-received by industry observers who expect the proposals to facilitate more value-based payments and coordinated care.

In two proposed rules from the CMS and HHS Office of Inspector General, the agencies said the current regulations limit data sharing and care coordination in their attempts to root out fraud.

Under the proposed rules, specialty physician practices could share patient information with primary care physicians to manage care or work with hospitals on discharges using data analytics. It also would allow local hospitals to work together on cybersecurity issues without running afoul of data sharing concerns.

The safe harbors include allowing hospitals to pay physicians incentives as part of CMS-sponsored care models.

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