CMS eyes new referral rules
Compliance Monitor, October 25, 2006
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CMS plans to propose new rules that would limit the "in-office ancillary services" exception to federal self-referral law, United Press International (UPI) reports.
CMS is investigating the extent to which physicians may be taking excessive profit from diagnostic services, such as MRI, CT and PET scans, according to an investigation by the Wall Street Journal.
Despite a ban on referring patients to outside facilities to which doctors have financial ties, federal law makes one exception for doctors, which allows them to perform tests on site or at a facility they lease for that purpose.
CMS worries that outside facilities are being operated by contractors to the medical practice. Under these conditions, Medicare may also be billed for more than it pays to that outside contractor.
The new rules would also prevent doctors in some cases from charging Medicare more than the cost to perform the test, or what the physician paid for someone else to do it.
Click here to read the UPI story.
To read the Wall Street Journal report, click here (subscription required).
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