Mid-Atlantic Health Law TOPICS

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Did You Know? Spring 2009

Denial Code for Stark: Did you know that on January 1, 2009, Medicare instructed its contractors to use Claim Adjustment Reason Code #213 when denying claims because a physician has a financial interest in the entity providing a designated health service without satisfying an exception to the Stark law? Prior to January 1, 2009, there was no specific code to identify this type of denial. Health care providers and suppliers should monitor their Medicare reimbursement vouchers for this new code, and take action accordingly.

Non-Cash Gifts: Did you know that on January 1, 2009, Medicare increased the aggregate non-monetary compensation cap under Stark from $338 to $355? The Stark law generally prohibits physicians from receiving compensation from an entity that receives referrals of patients from that physician. However, non-cash gifts of a de minimis value are excepted from Stark, provided that the annual value of all gifts given to a particular physician in 2009 by a particular entity does not exceed $355.
Incidental Medical Staff Benefits: Did you know that Medicare also increased the medical staff incidental benefit cap from $29 to $30 per benefit, effective January 1, 2009? Certain non-monetary incidental medical staff benefits, such as free food, are also excluded from Stark if offered to all members of the medical staff in the same specialty, the benefit is provided on the hospital's campus, is reasonably related to the provision of care at the hospital and not related to the value or volume of referrals by the physician, and is offered during the times that the physician is providing services at the hospital. Each incident of the benefit must be valued at less than $30 per benefit and all incidents can be excluded in addition to de minimis items subject to the $355 aggregate non-monetary cap.


March 24, 2009




Rosen, Barry F.


Health Care