Improving the bottom line through a better understanding of rules and statutes

In an effort to improve their incomes, providers are often deterred from undertaking certain initiatives that they have heard to be illegal under various statutes or contracts. Though the statutes do limit joint ventures, certain referrals, and other practices, some of these beliefs are based on misinterpretations or "myths. " In reality, practitioners may have more flexibility than they assume. This article discusses some of the matters that confront practitioners in regard to Stark laws, anti-kickback regulations, and other statutes when they consider contractual arrangements with various sources of services for their patients. The authors explain why clinicians may have more recourse than they estimate in appealing Medicare reimbursement rulings.