Sources: 42 C.F.R. ยง 1001.952(s)
6. Specialty Referral Arrangements between Providers
Protects arrangements whereby one provider (which may be an individual or an entity) refers a specific patient to another provider, for specialty services, with the understanding that the specialty services provider will refer the patient back to the original provider at a certain time or under certain circumstances, as long as the following four standards are met:
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the mutually agreed upon time or circumstance for referring the patient back to the originating provider is clinically appropriate;
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the service for which the referral is made is not within the medical expertise of the referring provider, but is within the special expertise of the provider receiving the referral;
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the providers do not receive payment from each other for the referral and do not split a global fee from a federal health program; and
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the only payments either provider receives are from the patient or third-party payors for services the provider performs.