Give leasing agreements for imaging services a close scan

Contract Language. By Steven M. Harris, AMNews contributor. Nov. 7, 2005.

CONTRACT LANGUAGE

A column examining the ins and outs of contract issues

SEE ARCHIVES

CT and MRI scanning have become one of the fastest-growing health care services in the United States. Projections for the total spent in this country on imaging services and new equipment is estimated to reach $100 billion this year.

With that kind of spending, leasing agreements for scanners have come under scrutiny due to the high volume of utilization in recent years, increased Medicare reimbursement and concerns regarding compliance with state and federal laws.

Leasing agreements for the provision of CT and MRI scanning services must be carefully structured to comply with state and federal regulations. If you are considering entering into a leasing agreement for CT or MRI services, you should determine how the arrangement will be structured to comply with the anti-kickback and Stark laws, if you are providing services to Medicare or Medicaid patients. In addition, state laws often regulate prohibited kickbacks and self-referrals.

In August, the Centers for Medicare & Medicaid Services published proposed revisions to the 2006 physician fee schedule. CMS has proposed including positron emission tomography and other nuclear medicine within the definition of "designated health services," and such services would be covered under the Stark II law. Nuclear medicine procedures currently are excluded from Stark II unless such services are performed as hospital inpatient or outpatient services.

Certain imaging leases in Florida and Louisiana have come under scrutiny due to suspect terms including financial relationships, the referral of patients outside the context of the imaging lease, and payments to physicians in exchange for patient referrals.