CMS Delays Implementation of New Anti-Markup Rules
As a result of comments by the physician community,
including AAPM&R, the Centers for Medicare and Medicaid Services (CMS) has
announced a one-year delay in the implementation of new anti-markup rules. The
Physiatrist previously reported that the anti-markup rules would be extended to
the professional component (PC), or interpretation, of diagnostic tests.
Currently, these rules only apply to the technical component (TC) of testing.
The final rule also prohibited the markup of both the TC and PC of diagnostic
tests ordered by a physician or group and performed by either an outside
supplier or outside of the billing physician’s office.
The final rule defined “office” as a place where the
physician or group provides the full range of services they typically offer.
Therefore, “office” would not include any off-site diagnostic testing facilities
or hospital outpatient locations. This provision would have had serious
implications for PM&R physicians. CMS now feels the definition of “office” is
not entirely clear and may have unintended consequences. They will be issuing
either clarifying guidance to what may be considered “office of the billing
physician or supplier” and/or propose additional rulemaking within the next
year.
The new effective date will be January 1, 2009. Current
anti-markup rules for the TC of diagnostic testing will remain applicable. | 
