Get the free CMS Voluntary Self-Referral Disclosure Protocol

Health Law Institute 201910501 Wednesday, March 13, 2019, Session #31: 2:25 p.m. 3:25 p.m. Preliminary Due Diligence Request List David C. Peck, Esq. Greenberg Training LLP Fort Lauderdale, FL Preliminary

How to fill out cms voluntary self-referral disclosure

How to fill out cms voluntary self-referral disclosure

1. Step 1: Obtain the CMS Voluntary Self-Referral Disclosure Form from the official CMS website.
2. Step 2: Read the instructions provided with the form carefully to understand the requirements and obligations involved in the disclosure process.
3. Step 3: Fill out the personal information section at the beginning of the form, including your name, contact information, and relevant identification numbers.
4. Step 4: Provide a detailed description of the disclosure, including the specific circumstances and any relevant background information.
5. Step 5: Identify and provide information about the referred parties involved in the disclosure, such as healthcare providers or organizations.
6. Step 6: Disclose any financial arrangements or relationships that may have influenced the referral, including any potential violations of the Stark Law or Anti-Kickback Statute.
7. Step 7: Attach any supporting documents or evidence that substantiate the disclosure and its implications.
8. Step 8: Review the completed form and ensure all required fields are filled accurately and completely.
9. Step 9: Submit the disclosure form to the appropriate CMS regional office as instructed in the form's instructions.
10. Step 10: Wait for the CMS to review the disclosure and communicate further instructions or actions to be taken.

Who needs cms voluntary self-referral disclosure?

1. CMS Voluntary Self-Referral Disclosure is needed by healthcare providers, organizations, or individuals who have identified or discovered potential violations of the Stark Law or Anti-Kickback Statute in their referral practices.
2. It is also relevant for those who want to voluntarily disclose such violations to CMS to mitigate potential penalties or legal consequences.
3. By submitting a voluntary self-referral disclosure, healthcare providers and organizations can demonstrate their commitment to compliance and transparency in their referral practices.

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What is cms voluntary self-referral disclosure?

CMS voluntary self-referral disclosure is a process where healthcare providers disclose actual or potential violations of Stark Law to CMS.

Who is required to file cms voluntary self-referral disclosure?

Healthcare providers who have identified actual or potential violations of Stark Law are required to file CMS voluntary self-referral disclosure.

How to fill out cms voluntary self-referral disclosure?

To fill out CMS voluntary self-referral disclosure, healthcare providers must submit specific information related to the violation, such as the nature of the violation, parties involved, and corrective actions taken.

What is the purpose of cms voluntary self-referral disclosure?

The purpose of CMS voluntary self-referral disclosure is to encourage healthcare providers to self-report actual or potential violations of Stark Law, and in return, they may receive reduced penalties.

What information must be reported on cms voluntary self-referral disclosure?

On CMS voluntary self-referral disclosure, healthcare providers must report details of the violation, financial impact, any corrective actions taken, and compliance program effectiveness.