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Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.
The Anti-Kickback Statute [1] (AKS) is an American federal law prohibiting financial payments or incentives for referring patients or generating federal healthcare business. . The law, codified at 42 U.S. Code § 1320a–7b(b), [2] imposes criminal and, particularly in association with the federal False Claims Act, civil liability on those who knowingly and willfully offer, solicit, receive ...
Confidentiality is an important issue in primary care ethics, where physicians care for many patients from the same family and community, and where third parties often request information from the considerable medical database typically gathered in primary health care.
In medicine, referral is the transfer of care for a patient from one clinician or clinic to another by request. [ 1 ] [ 2 ] Tertiary care is usually done by referral from primary or secondary medical care personnel.
Clinical documentation improvement (CDI), also known as "clinical documentation integrity", is the best practices, processes, technology, people, and joint effort between providers and billers that advocates the completeness, precision, and validity of provider documentation inherent to transaction code sets (e.g. ICD-10-CM, ICD-10-PCS, CPT, HCPCS) sanctioned by the Health Insurance ...
The Healthcare Quality Improvement Act of 1986 (HCQIA) of the United States was introduced by Congressman Ron Wyden from Oregon. ( Title 42 of the United States Code , Sections 11101 - 11152) It followed a federal antitrust suit by a surgeon against an Astoria hospital and members of its clinic in which he claimed antitrust actions were ...
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A 2007 study found that a patient being cared for by a physician who practiced self-referral for imaging studies was 1.196 to 3.228 times more likely to have an imaging study done as compared to a patient being cared for by a physician who did not practice self-referral. [4]