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The American Medical Association and 47 national physician organizations have convinced the Centers for Medicare & Medicaid Services (CMS) to delay until Jan. 1, 2009, enforcing most of the expanded "anti-markup rule" in the 2008 physician fee schedule.
The rule limits the payment a physician can receive for the technical component of services he or she purchases from an outside supplier, said AMA Federal Relations Director Terri Marchiori. In its expanded form, she said, the new rule applies the same payment limitation to the professional component of purchased diagnostic tests, as well as to the technical and professional components of services performed by employees of physicians or group practices if the services are performed outside the office of the physician or group practice. The new provision defines the office of a group practice as space where the group provides substantially the full range of patient care services that it provides generally.
There is one exception to the delay, Ms, Marchiori said. It does not apply to anatomic pathology diagnostic testing services furnished in space used by a physician group practice as a "centralized building." This essentially means this postponement only applies to diagnostic pathology services when the group provides other patient care services at the site as well, she said. This is intended to close a perceived loophole in the self-referral regulations that had allowed the operation of off-site "pod labs."
Ms. Marchiori says CMS intends CMS to use the one-year delay to clarify the application of the rule, issue an additional proposed rule, or both. She added the AMA will continue its efforts to ensure that the new rules do not have unintended negative consequences for patient access to diagnostic tests.
Last Published: 1/14/2008 Print this page
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