11月20日, 2020, CMS发布了一项最终规则,以现代化和澄清解释医疗保险bet8网站备用自我转诊法的规定(斯塔克法).在心电图, we want to ensure we continue to provide accurate guidance regarding the regulatory environment. CMS stated in the proposed (and final) Stark law rule that it believes clear, bright-line rules would enhance stakeholder compliance efforts and enforcement capability. 对最终规则的评论和回应为加强心电图的评估方法和方法提供了重要的见解.
The Review Process for Fair Market Value and Commercial Reasonableness
In developing the final rule, the government considered three basic questions:
- Does the arrangement make sense as a means to accomplish the parties’ goals?
- How did the parties calculate the remuneration?
- Did the calculation result in compensation that is fair market value for the asset, 项, bet8娱乐, 或出租物业?
These questions relate, 分别, to the definition of commercial reasonableness, the volume or value standard and the other-business-generated standard, and the definition of fair market value.
The Importance of Substantive Compliance
The government clearly stated the importance of documentation:
bet8网站备用(或bet8网站备用的直系亲属)与bet8网站备用转诊到指定医疗bet8娱乐机构的实体之间是否存在经济关系, compliance with the physician self-referral law requires substantive compliance, not merely documentary (or “纸”)合规 [all emphasis added], with the requirements of an applicable exception. 一个不可辩驳的商业合理性推定,确保当事人不受违反《bet8娱乐》的指控,如果他们的文件包括特定的语言或他们的安排最终达到了预期的目的,将构成项目或患者虐待的风险.
As valuation experts, we are particularly focused on the government’s position on compensation and production surveys. Here are the key excerpts from the Medicare Program; Modernizing and Clarifying the Physician Self-Referral Regulations (Centers for Medicare & Medicaid bet8娱乐), 联邦公报, December 2, 2020, 85 FR 77492 final rule regarding surveys (emphasis added):
- “从评论中可以看出,利益相关者可能有这样的印象,即CMS的政策将导致对工资调查的依赖, 在所有情况下, in a determination of fair market value for a physician’s professional bet8娱乐s. 工资调查在所有情况下都必须提供公平市场价值的准确判断,这并不是CMS的政策.”
- ”咨询 工资计划 or other hypothetical data is an appropriate starting point in the determination of fair market value, and in many cases, it may be all that is required.”
- “We agree with the commenter that asserted that a hospital may find it necessary to pay a physician above what is in the salary schedule, especially where there is a compelling need for the physician’s bet8娱乐s.”
- “我们认为, each compensation arrangement is different and must be evaluated based on its unique factors. That is not to say that common arrangements, 无论提供bet8娱乐的bet8网站备用的身份如何,所要求的bet8娱乐都是相同的, 不适合使用薪酬调查来确定公平市场价值的薪酬吗.”
- “当事人不一定不能满足公平市场价值的要求,仅仅因为薪酬超过了薪酬表中的特定百分位数; 如果具体情况不能保证赔偿水平,当事人也不需要向bet8网站备用支付工资表中所示的金额.”
- “我们相信 工资计划 should not be used by a physician to demand compensation 这高于消息灵通的各方,他们不能为彼此创造业务,他们会同意bet8网站备用bet8娱乐的公平市场价值.”
- “We wish to be perfectly clear that 我们评论中的任何内容都无意暗示所有补偿安排都需要独立估值.”
- “我们不确定为什么评论者认为CMS的政策是将薪酬设定在工资表的第75个百分位或以下总是合适的, and that compensation set above the 75th percentile is suspect, if not presumed inappropriate. The commenters are incorrect that this is CMS policy.”
心电图 recommends that each organization use an internal review framework to determine:
- Fair market value and commercially reasonable compensation. As explicitly noted in the remarks quoted above, it may not be appropriate to use a global benchmark percentile range (e.g., 25th to 75th percentiles) to document reasonable compensation levels.
- Defined survey sources should be utilized to set compensation percentile parameters. 我们建议根据你方特定市场的事实和情况来设定参数. These parameters may vary depending on provider cohort (e.g., primary care, medical, surgical, hospital based). Furthermore, these ranges may differ depending on other conditions (e.g., community need, timely access to healthcare bet8娱乐s, provision of charity care).
- When it is necessary to seek an independent/external reasonableness review/opinion.
With the insights gained from the CMS final rule and commentary, 我们的评估方法和方法将继续加强我们对每次审查的定性方法.
Clarity Regarding the Big Three and Fair Market Value/Commercial Reasonableness Definitions
CMS最终规则建立了bet8网站备用自我转诊法的新例外,并就如何更好地解释现有规则和法规提供了额外的指导.
The rule provided modifications to the terms “fair market value” and “general market value.它还最后确定了如何解释“商业合理性”的具体措辞,并进一步界定了补偿安排应考虑到转介的数量或价值的条件.
- 按照规则, fair market value means “the value in arm’s-length transactions, consistent with the general market value.”
- 一般市场价值指的是“一项资产在消息灵通的买家和卖家之间进行真诚的讨价还价后所带来的价格,否则他们就无法为另一方创造业务。.”
Regarding commercial reasonableness, CMS发现,由于缺乏编纂的定义,导致对一项安排的商业合理性的评价被误解为公平的市场估价. 一项交易的商业合理性是一种不同于该安排是否产生公平市场价值的补偿的考虑.
“商业合理性”的新定义是指该特定安排促进了安排各方的合法商业目的,并且是 明智的,考虑各方的特点,包括其规模、类型、范围和专业. 一项安排即使没有给一方或多方带来利润,也可能在商业上是合理的.”
必须指出的是,一项安排缺乏盈利能力并不一定妨碍它在商业上是合理的, as might have been a common misconception in the past. 各方签订无利润安排的原因包括社区需要, provision of timely access to healthcare bet8娱乐s, fulfillment of licensure or regulatory obligations (including those under the EMTALA), provision of charity care, and improvement of quality and health outcomes.
最后, CMS澄清了考虑到转诊数量或价值的补偿的具体情况. Under the final rule, ,只有在用于计算补偿金额的数学公式中包括转诊作为一种 变量, 补偿的数额与bet8网站备用转诊的数量或价值有关, is the compensation considered to take into account the volume or value of referrals.” This standard also applies to the value of “other business generated.”
上述定义和分析旨在为心电图的客户提供额外的清晰度,以保持对斯塔克法和反回扣法规的遵守.
请关注未来关于基于价值的安排如何被新的斯塔克规则赋予更多清晰度和自由度的帖子.
bet8娱乐Published December 21, 2020