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Medical staff incidental benefits

42 CFR § 411.357(m) provides an exception for medical staff incidental benefits -- defined as compensation in the form of items or services (not including cash or cash equivalents) from a hospital and other organizations with bona fide medical staffs, to a member of its medical staff.  This exception is designed to address certain routine situations involving medical staff benefits of nominal or small value. And although CMS takes the position that even relatively low levels of compensation could still potentially influence referrals, the small value of the benefit, along with other requirements under the rule, are deemed sufficient to minimize abuse.  The exception only applies to incidental benefits when the items or services are used on the hospital's campus, and only if all of the following conditions are met:
  • The compensation is provided to all members of the medical staff practicing in the same specialty (but not necessarily accepted by every member to whom it is offered) without regard to the volume or value of referrals or other business generated between the parties;
  • Except with respect to identification of medical staff on a hospital Web site or in hospital advertising, the compensation is provided only when the medical staff members are making rounds or are engaged in other services or activities that benefit the hospital or its patients;
  • The compensation is provided by the hospital and used by the medical staff members only on the hospital's campus. Compensation, including but not limited to Internet access, pagers, or two-way radios, used away from the campus only to obtain hospital medical records or information or to contact patients or personnel on the hospital campus, as well as the identification of the medical staff on a hospital Web site or in hospital advertising, will meet the exception's "on campus'' requirement;
  • The compensation is reasonably related to the provision of, or designed to facilitate directly or indirectly the delivery of medical services at the hospital;
  • The compensation’s value is  less than $25 with respect to each occurrence of the benefit (for example, each meal given to a physician while he or she is serving patients) – although this amount is adjusted annually;
  • The compensation is not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties; and
  • The compensation arrangement does not violate the antikickback statute, or any federal or state law or regulation governing billing or claims submission.
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