CMS Tackles Doctor Self-Referral Practices That May Drive Up Test Volumes
This article was originally published in The Gray Sheet
Executive Summary
CMS is cracking down on physician self-referral in an effort to curb over-use of diagnostic tests and imaging services
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Medicare In Brief
Diagnostic anti-markup provision delayed: Rampant confusion and concern among stakeholders compels CMS to postpone implementing an anti-markup provision for diagnostic tests performed at a site other than the billing physician's office. The provision, originally set to go into effect Jan. 1 with the 2008 physician fee schedule, is intended to reduce self-referral profit incentives for unnecessary tests (1"The Gray Sheet" July 9, 2007, p. 13). However, "patient access to common diagnostic tests may be significantly disrupted unless we delay the effective date," CMS says in the Jan. 3 Federal Register, pushing the date back one year except for certain anatomic pathology tests. CMS plans to issue a clarifying guidance, propose additional rulemaking, or do both within the next 12 months
Medicare In Brief
Diagnostic anti-markup provision delayed: Rampant confusion and concern among stakeholders compels CMS to postpone implementing an anti-markup provision for diagnostic tests performed at a site other than the billing physician's office. The provision, originally set to go into effect Jan. 1 with the 2008 physician fee schedule, is intended to reduce self-referral profit incentives for unnecessary tests (1"The Gray Sheet" July 9, 2007, p. 13). However, "patient access to common diagnostic tests may be significantly disrupted unless we delay the effective date," CMS says in the Jan. 3 Federal Register, pushing the date back one year except for certain anatomic pathology tests. CMS plans to issue a clarifying guidance, propose additional rulemaking, or do both within the next 12 months
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