1. Can I service my Medicare/Medicaid patients at an IDC facility?
2.   Will I need to obtain a new Medicare provider number?
3.   How does the lease-back concept fit within Stark and Anti-Kickback legislation?
4.   What is the compensation arrangement at IDC?
5.   Can I simply pay a fee per procedure and still bill and collect for that procedure?
6.  

An existing imaging center in my market has proposed a similar lease-back opportunity to me. Are there any issues I should be aware of?

7. What authority will I have over IDC employees
8. Am I subject to a long-term agreement with IDC?
9. What radiology arrangements will be made for my studies to be read?
10.   Do I need to hold an NRC License in order to lease Nuclear Medicine or PET Scan time at IDC?
11. What type of equipment will be available at IDC?
12.   How will patients be scheduled in the center?
13.   Do I need to be in the IDC office when my patients are being seen?
14.   Who will do my billing for these procedures?
15.   How will my primary office staff know how to work with the IDC office staff?
   

Can I service my Medicare/Medicaid patients at an IDC facility?

Yes, with some limitations. You may provide any service that is not considered a "designated health service" to your Medicare and Medicaid patients via your IDC facility lease. This would include Cardiac Cath, Nuclear Medicine, PET Scanning and Pain Management procedures.

Should you wish for your government patients to receive MRI, CT or Ultrasound services, they can still receive these at your IDC facility, under the care of a leasing radiologist who will provide and bill for these services, rather than through your lease agreement.

Under the IDC leaseback model, you may provide MRI, CT and Ultrasound services to your non-government patients without violating Stark and Anti-Kickback laws.

Will I need to obtain a new Medicare provider number?

No. If you are leasing time for non-designated health services, the IDC facility becomes an extension of your practice for your scheduled period of time. Thus, you can bill and collect for diagnostic services performed at IDC under your existing Medicare provider number.

How does the lease-back concept fit within Stark and Anti-Kickback legislation?

IDC's unique lease-back concept complies fully with Stark legislation under the "In-Office Ancillary Services," "Lease Arrangements," and "Fair Market Value Compensation" arrangements. Our model complies with Anti-Kickback legislation under the "Management Services" and "Lease Arrangements" Safe Harbors. The IDC Legal Review provides complete details as outlined by healthcare legal experts Jenkens & Gilchrist PC; their full legal opinion is also available for review.

What is the compensation arrangement at IDC?

You pay IDC a set monthly lease rate for the facility, employees and equipment, based on the annual number of hours contracted for each modality. Contract time required is determined through a rigorous analysis of your practice's current referral patterns for diagnostic services, and is pre-set for the contract period (in order to comply with regulatory requirements).

Through this arrangement, the IDC facility is simply an extension of your practice during your leased time. You bill and collect the technical fee for each procedure performed (or, the global fee for procedures performed by you or a physician with whom you subcontract).


Can I simply pay a fee per procedure and still bill and collect for that procedure?


No. IDC maintains responsibility for offering a legally sound product to our customers; a fee per procedure (or "per-click") arrangement gives rise to several legal issues.

The Stark and Medicare Anti-Kickback laws respectively prohibit a physician from referring government patients to a facility in which the physician has a financial interest and prohibit an exchange of value between a physician for the referral of such patients unless certain exception criteria are met. In other words, there can be no relationship between physician remuneration and volume of referrals.

According to the OIG, percentage or per-use arrangements between health care providers (i.e. imaging centers, hospitals, physicians) in a position to refer Medicare or Medicaid business may violate the Anti-Kickback statute, because the payments are directly tied to the volume of business or amount of revenue generated, providing an improper incentive to refer. Thus, these arrangements are subject to heightened scrutiny and have been specifically addressed by HCFA and OIG. A "per-click" arrangement also raises scrutiny from the Stark perspective, since the relevant Stark exception states that rental charges and fees must not be determined in a manner that accounts for the volume or value of any referrals or other business generated between the parties. A "per-click" arrangement clearly links rental fees to volume of referrals.

An existing imaging center in my market has proposed a similar lease-back opportunity to me. Are there any issues I should be aware of?

Any imaging center that is a 'provider' (i.e. bills and collects for diagnostic imaging services under its own tax ID number), yet also offers a lease-back model, is subject to legal scrutiny.

According to Stark, a compensation arrangement between an imaging center and a physician group prohibits the group from referring a Medicare or Medicaid patient to that center, and prohibits the center from billing to Medicare or Medicaid for that patient, unless specific Stark exception criteria are met. Thus, in an imaging center that is also a 'provider,' physicians cannot provide diagnostic services to government patients under their lease-back arrangement. Furthermore, even if no Medicare and Medicaid patients flow through the lease-back arrangement, the lease-back arrangement is not protected under Stark if government patient referrals are otherwise made between the parties.
If an imaging center that is also a 'provider' is offering a "per-click" arrangement to leasing physicians the arrangement is subject to heightened legal scrutiny for the reasons addressed here as well as those addressed in the "fee-per-procedure" discussion (above).

Since IDC will NEVER directly bill and collect for services provided to ANY patient, we are not considered a 'provider' of health care services and are not subject to provider-based restrictions. Thus, the IDC model fits more soundly within the framework of current regulations than any structure an existing, 'retail' imaging center is able to offer.

What authority will I have over IDC employees?

IDC employees specific to a given modality become your employees during the time you lease that modality at IDC. During your leased time you will have authority over these employees just as you would in your primary office, and will share with other leasing physicians in the overall responsibility for hiring, firing and ongoing personnel management decisions. The day-to-day responsibility is delegated to an on-site IDC manager on your behalf.

Am I subject to a long-term agreement with IDC?

No. By law you must have at least a one-year lease, in order for the arrangement to qualify for regulatory exemptions. However, your profit potential with IDC is maximized through longer lease terms (three to five years).

What radiology arrangements will be made for my studies to be read?

Each IDC facility will arrange for a radiologist or radiology group leasing time at the center, to provide clinical supervision and reading services for procedures provided there. However, your practice may choose to use the radiologist/group of your choice to read your studies. Your practice makes these arrangements directly with the radiologist/group, allowing you maximum control over economics, process and turnaround. With certain modalities and specialties (i.e. cardiologists and Nuclear Medicine, or Neurologists and MRI), you may wish to read your own studies; this arrangement is acceptable at IDC.

Do I need to hold an NRC License in order to lease Nuclear Medicine or PET Scan time at IDC?

No, it is not necessary for individual leasing physicians to be licensed in nuclear medicine. The IDC facility must and will be licensed. A designated safety officer must provide oversight to ensure the center continually meets licensure requirements, and typically performs quarterly audits. This safety officer is designated by IDC and may be a leasing physician, a separately contracted physician or a nuclear physicist. In addition, any physician reading individual patient studies must be licensed in Nuclear Medicine. However, as indicated in the "radiology" question above, the leasing physician group may arrange with whomever they choose to perform this function.

What type of equipment will be available at IDC?

IDC centers will be furnished with state-of-the-art equipment for all modalities, with upgrade capacity to accommodate technological advances. In order to benefit from economies of scale and share that benefit with leasing physicians, IDC will work nationally with manufacturers to equip all centers across the country. These vendors are chosen with input from clinicians in all specialties, ensuring an effective balance between cost-effectiveness and clinical/operational advantage.

How will patients be scheduled in the center?

IDC offers two lease scheduling methods, depending on physician preference for each modality contracted:

"Block" Time: your monthly lease time is scheduled during specific hours and days of the week. Physicians typically choose this option for modalities where they performs the service personally (such as with various Cardiac procedures), or otherwise prefer to be on-site at IDC during their leased time. In this arrangement, the leasing physician practice will schedule patients who are to be seen at the IDC site of service during their leased time period; IDC will make reminder calls to those patients the day before they are to be seen.
"Flex" Time: your patients may be scheduled at any convenient time during the week, much like they would at another imaging center. The leasing practice will contact the scheduler at the IDC facility to schedule all patients to be seen. The scheduled time will be calculated on a quarterly basis according to the terms of the IDC Sublease.

Do I need to be in the IDC office when my patients are being seen?

Not usually, although a specific answer depends on the 'Incident To' physician supervision requirements for the modality being leased. For most modalities, 'Incident To' simply requires either a physician member or agent of the leasing physician group be on-site for the procedure, but not necessarily in the procedure room. In some states, the member or agent can be a nurse practitioner or physician's assistant. Leasing physician groups can arrange this on their own, or IDC can facilitate a sub-contractual arrangement with a physician or agent who will be on-site at the IDC location at all times. At most IDC facilities, this supervision can be provided by the radiology practice affiliated with the center.

Who will do my billing for these procedures?

Since IDC is an extension of your practice, your office bills and collects for all procedures performed in the IDC center. IDC provides training and resources to make this as easy as possible for your billing staff.

For each patient seen, the technician performing the procedure will complete a comprehensive Charge Capture Sheet indicating the specific CPT codes for the procedure performed. At the end of each day during which you have serviced scheduled patients, these sheets will be faxed to your billing office, and information can simply be input from the Charge Capture Sheet into your billing system.

How will my primary office staff know how to work with the IDC office staff?

Once a lease agreement is signed with your practice, IDC will conduct an on-site orientation with your office staff, to review all scheduling and billing procedures. Any person you designate may attend, but it is highly recommended that your practice administrator and nurse supervisor attend, and that you have representation from your scheduling and billing staff.

 

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