August 2008
The Centers for Medicare and Medicaid Services (CMS) on June 30 announced proposed changes to the Medicare physician fee schedule (MPFS) for 2009. The proposed rule would cut payments to physicians by 5.4 percent unless Congress acts to reverse the cuts before Jan. 1, 2009.
Comments on the proposed rule are due on or before August 29. CMS will publish a final rule by November 1.
Under the rule, CMS is proposing to require that physicians and nonphysician practitioners (NPPs) who furnish diagnostic testing services meet most of the quality and performance standards required for independent diagnostic testing facilities (IDTFs), including, in part:
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Having technical staff on duty with the appropriate credentials to perform tests;
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Limiting a supervising physician to providing general supervision to no more than three IDTF sites;
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Requiring a supervising physician to prove proficiency in the performance and interpretation of each type of diagnostic procedure furnished in the office;
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Keeping equipment calibrated, maintaining it as indicated in the manual, and maintaining an inventory of diagnostic testing equipment;
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Maintaining a physical facility with space for equipment appropriate to the services designated on the enrollment application, adequate patient privacy accommodations, and storage of both business records and current medical records within the office setting; and
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Permitting unannounced and on-site inspections to confirm compliance with these standards.
CMS is specifically soliciting comments on whether to limit this enrollment requirement to less than the full range of diagnostic testing services and, if so, what criteria should be used to limit this provision. Examples of possible limitations include:
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Applying only to procedures that generally involve more costly testing and equipment;
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Applying only to imaging services or to only advanced imaging services, such as diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine (including positron emission tomography); or
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Excluding diagnostic testing services such as electrocardiograms or other diagnostic testing services frequently furnished by primary care physicians.
CMS is proposing to give physicians and NPPs who are currently enrolled in Medicare until Sept. 30, 2009, to comply with these standards, rather than the Jan. 1, 2009, effective date for the 2009 final rule.
The proposed rule also includes several changes to physician self-referral and anti-markup provisions, including an exception for incentive payment and shared savings programs. CMS has proposed an exception to the prohibition on physician self-referral that would permit remuneration provided by a hospital to physicians on its medical staff under incentive payment or shared savings programs, provided that specific conditions are satisfied.
The proposed rule includes two alternatives to revising the anti-markup rule. The first alternative would not require application of the anti-markup rule to 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. The second alternative would clarify anti-markup provisions that were finalized in the 2008 MPFS final rule by providing guidance pertaining to various terms of the rule, including what would constitute the "office of the billing physician or other supplier" and other concepts, such as "outside supplier."
For more on the proposed changes to the 2009 MPFS, see the next issue of Diagnostic Imaging Intelligence Report.
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August 2008 - Table of Contents
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