Published October 28, 2010

PPACA Provisions Effective Immediately

Pursuant to the recently passed Patient Protection and Affordable Care Act (PPACA), certain provisions will become effective over several years while others require immediate implementation. Outlined below are two key issues that require immediate consideration:

In-Office Imaging Services

  • The PPACA, in Section 6003, makes a key modification to the Stark law’s in-office ancillary services (IOAS) exception.
  • Previously, physicians have relied upon the IOAS exception in order to provide imaging services – including MRI, CT, and PET – to Medicare patients.
  • As part of the PPACA’s modifications, these physicians must now meet two additional requirements in order to rely on the IOAS with respect to these imaging services:
  • The referring physician must inform the patient, in writing and at the time of the referral, that the patient may obtain these services from another provider, and
  • The referring physician must provide the patient with a written list of suppliers who offer the service in the area in which the patient resides.
  • While the precise timing of these changes to the IOAS exception are somewhat vague, providers would be well-advised to proceed as if the changes have been implemented in order to avoid running afoul of the Stark law.

Refund of Overpayments

  • Section 6041 of the PPACA requires that physicians, hospitals, suppliers, and others must now:
  • Report and refund Medicare and Medicaid overpayments within 60 days of the date that the overpayment has been “identified,” and
  • Provide written notice of the reason for the overpayment.
  • Providers who fail to comply with this new measure will violate the False Claims Act and subject them to civil monetary penalties and exclusion from Medicare and Medicaid.

For additional information regarding the PPACA Provisions, please contact the expert listed below at (800) 270 9629

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