Legal issues affecting ancillaries and orthopedic practice.

The federal and state governments have imposed significant regulations on health care generally and on ancillary services in particular. This article focuses on how state and federal laws shape the ability of an orthopedic physician to offer ancillary services, whether as an individual, through a group practice, or as part of a joint venture. It focuses on how the Stark law, the Medicare anti-kickback statute, state anti-kickback, fee-splitting provisions, certificate of need laws, and various Medicare billing and supervision requirements impact the provision of ancillary services. It also briefly discusses how physicians should prepare for and respond to government investigations.

Legal billing for pathology services.

Minnesota physicians recently debated whether primary care physicians can legally and ethically "mark up" or add to the fees charged by a pathologist when submitting bills for pathology services to third-party payers. This article explores the relevant federal and state laws and offers the conclusion that both federal and state law allow for such a mark-up if it reflects reasonable compensation for additional work and risk assumed by the primary care provider group.

Improving the bottom line through a better understanding of rules and statutes.

In an effort to improve their incomes, providers are often deterred from undertaking certain initiatives that they have heard to be illegal under various statutes or contracts. Though the statutes do limit joint ventures, certain referrals, and other practices, some of these beliefs are based on misinterpretations or "myths. " In reality, practitioners may have more flexibility than they assume. This article discusses some of the matters that confront practitioners in regard to Stark laws, anti-kickback regulations, and other statutes when they consider contractual arrangements with various sources of services for their patients. The authors explain why clinicians may have more recourse than they estimate in appealing Medicare reimbursement rulings.

Keeping internal chart reviews from being used against you: 11 useful strategies.

Internal chart reviews are useful tools for practices to determine the accuracy of their coding when billing for services, especially to governmental payers. They can also boomerang, however, and be used as evidence against a practice when their results are not fully understood or implemented. This article provides some guidance to help practitioners realize the fuller value of chart reviews in terms of over- and under-coding, adequacy of documentation, and attorney-client privilege.

Regulation of ancillary services.

Operation of ancillary services is highly regulated. The regulations are not always logical, but they are navigable. Be sure to work with a health care attorney who is familiar with the rules. Be careful to fully disclose all relevant facts. Most importantly, ask a lot of questions. The rules are complicated, but they are understandable. By being inquisitive, you will be able to determine whether your legal or consulting expert has a good understanding of the rules. If you work together, it is usually possible to structure the ancillary service in a way that can be both safe and profitable.