Corporate Compliance

CMS delays implementing parts of the anti-markup provision

Compliance Monitor, January 9, 2008

CMS will delay implementation of parts of the anti-markup provision until January 1, 2009, according to a final rule published in the Federal Register on January 3, 2008. The revised rule had been scheduled to go into effect on January 1, 2008.

Under the revised rule, payment for the technical component and professional component of diagnostic tests purchased by physicians or suppliers from an outside supplier or performed at sites other than the "office of the billing physician or other supplier" is limited to the lowest of:

  • the performing supplier's net charge to the billing physician or supplier
  • the billing physician or supplier's actual charge
  • the fee schedule amount

During the comment period, CMS received feedback that the definition of "office of the billing physician or other supplier" is unclear and could have unintended consequences. CMS decided to postpone implementing the rule for one year to study the issue further.

Provisions regarding the technical component of all purchased diagnostic tests and anatomic pathology diagnostic testing services furnished in space that is utilized by a physician group practice as a "centralized building" that does not qualify as a "same building" under the Stark Law are not included in the delay.

Click here to read the notice in the Federal Register.

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