What Are Designated Health Services? (+ How They Relate to Medicare Billing)

September 21, 2022 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Practice Management

Don’t you love how easy it is to understand the Medicare billing process? There are hardly any acronyms or complicated regulations; it’s a breeze!

Said no one, ever.

As you likely know, Medicare billing is a process that takes time, attention, and at least a headache or two to work through. It seems like a never-ending wealth of information, legislation, abbreviations, and particulars! 

At NCG Medical, we know your pain so we’re here to help illuminate the medical billing process one article at a time. In this blog, we’ll break down a component pertaining to a law pertaining to Medicare billing–specifically, we’ll talk about designated health services and how they relate to Stark Law, which impacts Medicare billing.

Keep reading to learn more!

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What Is DHS?

Designated health services, known as DHS, is an umbrella term referring to services that can be reimbursed by Medicare. As you might guess, this includes a whole host of possible health services, including:

  • Lab services
  • Radiology and imaging services
  • Physical, occupational, speech-language, and other types of therapies
  • Radiation therapy services
  • Medical equipment and supplies
  • Parenteral and enteral equipment, supplies, and nutrients
  • Home health services
  • Prescription drugs
  • Inpatient and outpatient hospital services
  • And more!

As mentioned earlier, designated health services pertain to a particular legislative initiative known as Stark Law. Colloquially referred to as the “physician self-referral law” and officially titled “Ethics in Patient Referrals Act”, this bill was passed in 1989.

Stark Law contains three key components: 

  1. It prohibits healthcare providers from referring Medicare patients for certain health services to a business in which the physician has a vested interest, whether financial or familial
  2. The law also prohibits the billing of Medicare or other insurance providers for health services when an improper physician referral was made
  3. Stark Law also grants the secretary of the Department of Health and Human Services the authority to create specific exceptions for referrals to entities or medical provider businesses that will not result in a conflict of interest 

It’s worth noting that there are numerous exceptions to this legislation, including: 

  • Referrals to academic medical centers
  • In-office ancillary services, like providing a wheelchair 
  • Physician services where the physician is a member of the same group practice
  • Some clinical laboratory services, such as preventative screenings or vaccinations 

And of course, if your medical practice doesn’t treat patients covered by Medicare, then this legislation doesn’t apply to you.

Designated health services relate to Stark Law, which impacts Medicare billing

How Does DHS Relate to Medicare Billing?

Since designated health services are part of Stark Law, which pertains to Medicare billing, they’re important to note when sending your claims to CMS.

Consequences for violating Stark Law can range from fines of thousands of dollars to being excluded from all federal health programs; if your practice cares for patients covered by Medicare, you’ll want to ensure compliance when going through the medical billing process. 

If you have questions specific to your practice regarding Stark Law, be sure to contact an attorney in your area for further guidance.

Tips for Billing Medicare

The medical billing and coding process can be frustrating and complicated, especially when billing a government program. Here are some of our top tips for billing Medicare and keeping track of your DHS:

Keep Your Medical Documentation in Order

You know the saying, if it wasn’t written down then it didn’t happen? This is the golden rule in the world of medical documentation, especially in relation to Stark Law and designated health services. Be sure to keep every payment and information regarding each party involved with your medical practice in order so that you can maintain compliance.

Ensure Your Staff is Knowledgeable About Medicare and DHS

Knowledge is power; your staff can help keep your practice out of hot water by undergoing training related to Medicare billing, Stark Law, and designated health services. This is especially helpful when onboarding new staff members!

Submit Accurate, Completed Claims

It might sound obvious, but a key tip for billing Medicare is to submit claims that are completely filled out with comprehensive, accurate information. It’s estimated that up to 80% of medical bills contain errors, resulting in weeks of editing, resubmission, and providers not receiving their reimbursement. Each claim that needs to be reworked can cost your practice precious time, money, and energy!

Partner with a Medical Billing Firm!

Wish you didn’t have to stress about your medical billing and coding process? Outsource this critical part of your practice to a trusted medical billing firm like NCG Medical! Our friendly experts have decades of experience, and we operate as an extension of your practice, so your success is our success.

Enjoy a boosted revenue cycle with prompt payment and never have to worry about trying to understand esoteric legislation again. We’re eager to help your practice thrive, so let NCG Medical handle the medical billing burden!

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