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Can you summarize 34 PACO Section 127.301?
MEDICAL FEES AND FEE REVIEW > Referral standards.
Short Summary
This document governs referral standards in the context of workers’ compensation medical cost containment. It applies to providers, entities, and insurers involved in referrals for treatment and services. Under section 306(f.1)(3)(iii) of the act, providers are prohibited from referring a person for certain treatment and services if they have a financial interest with the person or the receiving entity. Claim for payment for services furnished under a prohibited referral is not allowed. However, referrals permitted under Safe Harbor regulations and exceptions to the Stark amendments are not considered prohibited referrals involving financial interest. It is important to note that a CCO (Certified Community Organization) is considered a single health care provider for the purposes of this document.
Whom does it apply to?
Providers, entities, and insurers involved in referrals for treatment and services
What does it govern?
Referral standards
What are exemptions?
Referrals permitted under Safe Harbor regulations and exceptions to the Stark amendments
What are the Penalties?
Not specified
Jurisdiction
Pennsylvania