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CMS Proceeds with Anti-Markup Rule for Pathology
The Centers for Medicare & Medicaid Services announced Dec. 28 a one-year delay in the implementation of the anti-markup rule, though declined, however, to delay the rule for pathology services.
The anti-markup rule applies to both the professional and technical component of anatomic pathology services, effective Jan. 1, 2008. CMS is delaying implementation of the anti-markup rule until Jan. 1, 2009 for other diagnostic testing services, stating it would further study the issue and consider a new rulemaking for non-pathology diagnostic testing services.
The announcement was published in the Jan. 3 Federal Register.
The College of American Pathologists previously published a detailed analysis of the anti-markup rule, which prevents an ordering physician from charging Medicare more than the net charge paid to a pathologist or other laboratory supplier for the pathology service if the service is performed outside of the office of the billing physician.
Following publication of the anti-markup rule as part of the final 2008 Physician Fee Schedule, the American Medical Association and other specialty medical organizations urged CMS to delay implementation. The AMA cited concerns for uncertainty in the rule and whether certain locations would meet the definition of the office of the billing physician.
The College organized a coalition of pathology and laboratory medicine organizations to oppose the delay and asked for immediate implementation to end abusive pod lab arrangements under Medicare. CMS agreed with the College and decided to proceed with the anti-markup rule to stop pod labs billing Medicare.
CMS stated in its announcement that anatomic pathology arrangements precipitated our proposal for revision of the anti-markup provisions and remain our core concern.
The anti-markup rule is effective for anatomic pathology services if the physician group is billing for services performed in a centralized building, and the location does not meet the definition of the same building, as both are defined in the Stark regulations.
Pod labs are defined by CMS as offsite from a physician office and must meet the definition of a centralized building to be compliant with the Stark Law. An in-office lab is likely to meet the definition of the "same building" and will not be subject to the Medicare anti-markup rule.
CMS remains committed to considering additional changes to the Stark regulations to stop other types of abusive contractual joint ventures. A proposed rule is expected in 2008.
The College advocates for changes to the in-office ancillary services exception to the Stark Law to prevent referring physicians from profiting from pathology services, regardless of whether the service is performed offsite or in-office. CAP will keep members informed of updates in future issues of Statline.
The Centers for Medicare & Medicaid Services announced Dec. 28 a one-year delay in the implementation of the anti-markup rule, though declined, however, to delay the rule for pathology services.
The anti-markup rule applies to both the professional and technical component of anatomic pathology services, effective Jan. 1, 2008. CMS is delaying implementation of the anti-markup rule until Jan. 1, 2009 for other diagnostic testing services, stating it would further study the issue and consider a new rulemaking for non-pathology diagnostic testing services.
The announcement was published in the Jan. 3 Federal Register.
The College of American Pathologists previously published a detailed analysis of the anti-markup rule, which prevents an ordering physician from charging Medicare more than the net charge paid to a pathologist or other laboratory supplier for the pathology service if the service is performed outside of the office of the billing physician.
Following publication of the anti-markup rule as part of the final 2008 Physician Fee Schedule, the American Medical Association and other specialty medical organizations urged CMS to delay implementation. The AMA cited concerns for uncertainty in the rule and whether certain locations would meet the definition of the office of the billing physician.
The College organized a coalition of pathology and laboratory medicine organizations to oppose the delay and asked for immediate implementation to end abusive pod lab arrangements under Medicare. CMS agreed with the College and decided to proceed with the anti-markup rule to stop pod labs billing Medicare.
CMS stated in its announcement that anatomic pathology arrangements precipitated our proposal for revision of the anti-markup provisions and remain our core concern.
The anti-markup rule is effective for anatomic pathology services if the physician group is billing for services performed in a centralized building, and the location does not meet the definition of the same building, as both are defined in the Stark regulations.
Pod labs are defined by CMS as offsite from a physician office and must meet the definition of a centralized building to be compliant with the Stark Law. An in-office lab is likely to meet the definition of the "same building" and will not be subject to the Medicare anti-markup rule.
CMS remains committed to considering additional changes to the Stark regulations to stop other types of abusive contractual joint ventures. A proposed rule is expected in 2008.
The College advocates for changes to the in-office ancillary services exception to the Stark Law to prevent referring physicians from profiting from pathology services, regardless of whether the service is performed offsite or in-office. CAP will keep members informed of updates in future issues of Statline.
