Subspecialty Gastrointestinal Pathology and Financial Relationships
Over the last decade, physician reimbursements have been declining steadily, both for clinical physicians (i.e. gastroenterologists) and for pathologists. To replace revenue lost from declining reimbursements, many physicians replace revenue by providing more services (seeing more patients) or explore capturing revenue from additional services (contract research or "ancillary services").
To ensure that physician's referral for additional services are motivated solely by the best interest of the patient, Federal Law (Stark) and many State laws prohibit physicians from referring patients to organizations or facilities in which they hold a financial interest and therefore would profit from the referral.
Several pathology companies that offer "subspecialty" pathology services also offer to clinical physicians mechanisms by which the referral of their patient's tissue biopsies to a specific laboratory may result in additional revenue for the physician's practice. These mechanisms are generally designed to be practiced within the boundaries of certain loopholes in Stark laws and state regulations.
These financial relationships include:
- Discounted client billing.
Client billing refers to a purchased services agreement between the physician caring for the patient and taking the biopsy and the pathology laboratory preparing the histologic slides and reviewing the biopsy material. The clinician and pathology company enter into a contract in which the clinician group buys pathology services from the pathologist at a rate substantially less than what the pathologist would be paid by insurance companies for the same service. The pathologist accepts payment from the clinician for the services as full compensation for pathology services. The clinician then bills and collection from the patient's insurance company for the full amount of the pathology service. In most instances, the clinician realizes a profit ($10 – 100) for each biopsy referred to the laboratory. - Condominium (pod) laboratories.
- Technical component/professional component splitting.
- Clinician owned histology laboratories.
- Reverse TC/PC splitting.
Read more about this topic: Gastrointestinal Pathology
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