The federal budget that was published this week calls for an elimination of the in-office ancillary exception for therapy services. Over the years a consensus developed with respect to therapy services that this lead to overutilization, and was not in keeping with the intent of the in-office ancillary exception to STARK. According to the rationle in the HHS “2014: Budget in Brief”
The in-office ancillary services exception was intended to allow physicians to self-refer quick turnaround services. While there are many appropriate uses for this exception, certain services, such as advanced imaging and outpatient therapy, are rarely performed on the same day as the related physician office visit.
The growth of physical therapy services provided in physician offices has been of topic of concern for both the Office of the Inspector General (OIG), as well as the American Physical Therapy Association. CMS in large reponse to concerns and OIG reports revised regulations for therapy provided incident-to physicians, and required that the rendering provider meet all CMS credentialing requirement short of licensure. Additionally PTAs cannot practice incident-to the physician.
According to the HHS Budget summary, beginning in January of 2015, eliminating the use of the in-office ancillary exception for therapy (along with the elimination of radiation and advanced imaging) services to the “prohibition against physician self-referrals” (Starklaw), except in cases where a practice meets certain accountability standards, as defined by the Secretary is project to save $6.1 Billion over 10 years.
[$6.1 billion in savings over 10 years]