OIG changes its mind on referral services discounts

Share this article:
Government proposes long-term care EHR certification criteria, seeks provider comments
Government proposes long-term care EHR certification criteria, seeks provider comments

Providers cannot use an online service that involves money for referrals within its network, federal regulars now say, reversing course on an advisory opinion issued three years ago. The edict came from the Department of Health and Human Services Office of Inspector General.

The notice of termination on OIG Advisory Opinion No. 11-18 was posted Tuesday. In 2011, the OIG had said there was a low risk from an arrangement that electronically facilitated patients between a network, or to other “trading partners.”

“Under the Arrangement, Ordering Health Professionals who purchase the Coordination Service Package receive a discount on their monthly EHR Service subscription fees. Each time an Ordering Health Professional uses the Coordination Service to make a referral to a Non-Trading Partner, the discount is reduced by an amount equal to or less than $1, until it disappears entirely,” the notice explains. 

The discount fee was small enough that the OIG concluded it was unlikely to influence an ordering health professional's referral decisions.

But the OIG reversed course because of the potential for a professional, such as a physician, to choose a partner in network for services with a high degree of frequency (specifically, laboratory tests).

While the OIG redacts names in its opinions, the Bureau of National Affairs said athenahealth Inc. announced separately it had requested the opinion.

Share this article:

More in News

Skilled nursing facility trends contribute to improved Medicare outlook, Congressional report says

The Medicare trust fund is on track to remain solvent until 2030, trustees of the program stated in a Congressional report released Monday. This improved outlook is due in part to revised expectations about the case mix in skilled nursing facilities.

House bill would define, promote coordinated long-term care services

A bill introduced in the House of Representatives would target improved care coordination for seniors, also adding it under the Older Americans Act.

Seize the day: Tech Awards deadline is tomorrow

Seize the day: Tech Awards deadline is tomorrow

The final countdown has begun: Long-term care providers have less than 48 hours to enter the third annual McKnight's Excellence in Technology Awards. Submissions will be accepted through July 30.