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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

Will Crackdown On “Pod Labs” Have Consequences For Diagnostic Services?

A CMS plan to crack down on abuse by "pod labs" is generating a mixed response, as stakeholders predict unintended consequences for diagnostic services

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