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Stark and Anti-kickback Protections for Giving EHR and e-Prescribing to Physicians. Website Slides Alice G. Gosfield. Who can give . Electronic prescribing: Same Hospital to member of medical staff PDP sponsor or MA organization Group practice to a “ member ” EHR:
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Stark and Anti-kickback Protections for Giving EHR and e-Prescribing to Physicians Website Slides Alice G. Gosfield c.2006 Alice G. Gosfield
Who can give • Electronic prescribing: Same • Hospital to member of medical staff • PDP sponsor or MA organization • Group practice to a “member” • EHR: • Those plus, an ‘entity’ under Stark; • For AKS – any entity which provides services and submits claims under a federal health care program c.2006, Alice G. Gosfield
Who can receive • A physician on staff of a hospital as long as eligibility does not take into account volume or value or referrals • Things that are OK to consider: • Total # of scripts; size of practice (e.g., # of pts, pt encounters, or RVUs); total # of hrs physician works; overall use of automated technology in the practice; level of uncompensated care physician renders • Any other reasonable and verifiable judgment not reflective of volume or value of referrals c.2006, Alice G. Gosfield
What can be given • Electronic prescribing items and services • Hardware, software or information technology, training services “necessary and used solely to receive and transmit electronic prescription info” • Electronic health records • Software or IT and training “necessary and used predominately” for HER – no hardware c.2006, Alice G. Gosfield
Conditions for Prescribing IT:Written Agreement and More • System meets Part D standards • Donor does not limit or restrict use or compatibility with other electronic or EHR systems • System can be used for any patient • Receipt of system is not a condition of referrals by recipient • Donor has no knowledge or does not act in reckless disregard or deliberate ignorance of whether the physician has equivalent services or items c.2006, Alice G. Gosfield
Conditions for EHR: Written Agreement and More • Software is interoperable as certified no more than 12 mos before by proper agency • No limitations on uses with other IT • Before receipt, physician pays 15% of donor’s cost for items or services • No donor loans for the payment • Recipient doesn’t condition receipt on referrals • No donor knowledge of physician’s having equivalent IT c.2006, Alice G. Gosfield
EHR Conditions (2) • Can be used for all patients • Donation does not include staffing of physician offices and is not used primarily for personal business or business unrelated to the medical practice • The software contains electronic prescribing capability or the ability to interface with the physician’s electronic prescribing system c.2006, Alice G. Gosfield