decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Entity / Overview
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Article Overview
This overview is about Stark law terminology and how the term entity is defined and applied in physician self-referral compliance. It is intended for coding, compliance, and reimbursement professionals who need to understand the scope of the rule as it relates to practices, facilities, health plans, and related arrangements. The article focuses on statutory and regulatory references, the types of organizations that may fall within the definition, and related considerations for payment arrangements under federal rules.
Why This Topic Matters
Understanding the Stark definition of entity is important for compliance review, referral relationships, and claims/billing analysis. The article helps readers recognize which organizations may be treated as the furnishing entity under federal self-referral rules and where exceptions or special arrangements are discussed.
What You Will Learn
- How Stark law uses the term entity in the physician self-referral context
- Which broad organization types are discussed in relation to the definition of entity
- How under arrangement and reassignment concepts are framed at a high level
- Why the topic matters for Stark compliance and billing review
Who Should Read This
- Medical coders
- Compliance professionals
- Revenue cycle staff
- Physician practice administrators
- Healthcare attorneys
- Billing specialists
Codes Discussed
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