Demystifying the Stark Law’s Overhauled Big 3: Commercial Reasonableness, Volume or Value and FMV (2021 PHS Single Session)

6. Demystifying the Stark Law’s Overhauled Big 3: Commercial Reasonableness, Volume or Value and FMV (2021 Physicians Program Single Session)
Kelly Cleary, Leia Olsen, and Joseph Wolfe

On January 19th new regulations went into effect aimed at modernizing and streamlining implementation of the Stark Law. The final rule that implemented the regulatory changes included extensive guidance from CMS on three critical regulatory requirements, fair market value, commercial reasonableness and the prohibition on “taking into account” the volume or value of a physician’s referrals. Notably, CMS proposed modifications to the fair market value definition, a new definition for commercial reasonableness and a bright-line standard for circumstances where compensation will be considered to “take into account” the volume or value of referrals. Our session will provide insight into the Big 3 and how the new guidance will impact health care contracting, compliance strategies and future enforcement priorities, including the following:

  • The reorganized FMV standard and important examples from the commentary
  • The new commercial reasonableness definition and clarifications from CMS regarding losses
  • The objective volume/value test and new guidance on directed referrals
  • The potential impact on physician arrangements, compliance strategies and enforcement
Continuing Education Credits are available for this session. For CLE credits, you can earn 1.0  credit hours on a 60-Min Calculation and 1.2 credit hours on a 50-minute Calculation. For CPE and CCB, you can earn 1.2 credit hours for this session.

AHLA would like to thank Pinnacle for sponsoring this CLE-eProgram session.