Recent developments and key legal issues impacting diagnostic imaging services, part 2.

Area of Science:

• Healthcare Policy
• Medical Billing
• Diagnostic Services

Background:

• The Centers for Medicare & Medicaid Services (CMS) has updated its anti-markup rule for diagnostic testing.
• Previous proposals for Independent Diagnostic Testing Facility (IDTF) enrollment were not implemented in 2009.
• The rule aims to clarify payment limitations for diagnostic testing arrangements.

Purpose of the Study:

• To explain the new flexible alternative approaches for determining anti-markup payment limitations.
• To inform providers about the implications of the finalized rule, particularly for mobile IDTFs.
• To alert imaging services providers about increased Medicare auditing and the expansion of the Recovery Audit Contractors program.

Main Methods:

• Analysis of Medicare's finalized anti-markup rule.
• Review of physician practice "shared practice" criteria for billing.
• Examination of CMS's decisions regarding IDTF enrollment and billing requirements.

Main Results:

• A flexible, two-alternative approach is now available to assess diagnostic testing arrangements for anti-markup rules.
• Mobile IDTFs must now enroll and bill Medicare directly for technical component services.
• CMS has made permanent and is expanding its Recovery Audit Contractors program, indicating increased auditing.

Conclusions:

• Healthcare providers, especially in diagnostic testing and imaging, must adapt to new compliance requirements.
• Direct billing by mobile IDTFs for technical components is now mandatory.
• Expect increased scrutiny and auditing from Medicare.