Radiology Healthcare Coding: Basic Facts on Stark Laws



Recent amendments to the Stark healthcare rules and exceptions in the final CMS payment rules have primarily affected diagnostic and imaging services. You must ensure that your practice/facility compliant. As to the Stark law and these related rules themselves, there's kind of more that they ask you to look at. So in this expert healthcare training article, we're getting some basic facts  and then we have to kind of delve into a bunch of information and kind of get the details of the arrangement.

First of all, we have to really know exactly what procedures we're talking about if we get it down to what CPT code we are intending to refer or to bill because a lot of this analysis really comes down to are you dealing with a service that's covered by these laws, not every service is.

And that becomes really important with radiology because there are certain types of radiological procedures particularly many invasive ones that may not, you know, trigger these rules. So, we really got to know exactly what we're talking about.


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We have to be concerned about whatever the financial relationship is. Is it an ownership compensation arrangement? Is it both ownership and compensation? What exactly is it? We do need to get an idea of location particularly if we're dealing with a multi-office location. What's happening in that office other than radiology or diagnostic imaging? Or is it just solely for that purpose? And where are - if we're talking about interpretation, where is that being conducted? Is it being conducted in somebody's house? Is it in a teleradiology center? Is it at the billing practice's location? Where is it exactly?


And then we need to know more about the players, you know, particularly the recipients, what type of entity it is. Is it licensed? Is it a Medicare provider? And often, we need to know that for the referrer as well.

And then as we talked about, we have to concerned about - are we talking about the technical component? About global billing or medical billing guidelines? What is it exactly? Our expert recommended in a healthcare event that as we have all these, you can see - what happens when you do this analysis you really got to get a lot of fact. And you also have to be really aware of the new ounces of radiology, of diagnostic imaging as it pertains to these laws.

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