CMS Continues Attempts to Address Anti-Markup Provisions with Two Alternatives

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Written by Staff

Sunday, 13 July 2008

CMS has proposed two alternatives to revise its anti-markup rule as part of its proposed 2009 changes to payment policies and rates under the Medicare physician fee schedule. 1. The application of the anti-markup rule would be waived for diagnostic testing services provided by a physician who shares a practice with a single physician or physician organization (In all other cases, the anti-markup rule would apply).

2. Anti-markup provisions that were finalized in the 2008 Medicare physician fee schedule final rule would be clarified by providing further guidance about the rule, including what would constitute the “office of the billing physician or other supplier” and other concepts such as “outside supplier.”

CMS is also soliciting comments about three issues pertaining to the anti-markup provision.

The definition of “net charge”.
Whether, in addition to or in lieu of the anti-markup provision, CMS should prohibit reassignment in certain situations and require the physician supervising the technical component or performing the professional component to bill Medicare directly.
Whether CMS should delay beyond January 1, 2009, the effective date of certain anti-markup provisions published in the 2008 Medicare physician fee schedule final rule, or delay the effective date of any proposed revisions to that rule, to the extent that they are finalized in the MPFS CY 2009 final rule, or both.

The anti-markup rule proposals begin on p. 44 of the proposed 2009 Medicare physician fee schedule.