Anti-markup Policy Changes Effect Physicians/Suppliers

The Centers for Medicare & Medicaid Services (CMS) is revising certain Medicare policy which may affect physicians and suppliers who submit claims for diagnostic tests to Medicare.

Revisions to Publication 100-04, Medicare Claims Processing Manual, chapter 1, sections 30.2.9 and (as codified in 42 CFR § 414.50) include two alternative methods for determining when to apply the anti-markup payment limitation, and changes to certain terminology.

These policy revisions, which go into effect March 15, were provisions of the 2008 Physician Fee Schedule (PFS) final rule (72 FR 66222) but were not finalized until the 2009 PFS final rule (73 FR 69799).

CMS Transmittal 1892, Change Request (CR) 6733 and Medicare Learning Network (MLN) Matters article MM6733 provide instructions for determining when the anti-markup payment limitation may apply to a physician/supplier submitting claims for diagnostic tests (other than clinical diagnostic laboratory tests) to Medicare.

Note that CMS also is replacing all references to the terms “purchased diagnostic test” and “purchased test interpretation” with “anti-markup test” or “diagnostic tests subject to the anti-markup payment limitation.”


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One Response to “Anti-markup Policy Changes Effect Physicians/Suppliers”

  1. Joan Magrane says:

    This means patients will not get the highest level of care if congress starts to cut spending on diagnostic tests. Will it come down to the fact of who is going to be dead and who is going to be alive ? What are we going to do eliminate the old and sick because these people are not cost effective in society?

    This bill is a bad idea the more I read of it the worse it gets people will BE OUT OF WORK DOCTORS, TECHS BILLERS & CODERS, why should people go to school to train for a field in medicine if the job will not pay a wage that you can live on.

    If we are to cut cost let us start with the big business pharmacy’s I am not paying for a commercial for Viagra on prime time TV or for fancy packaging. For Durable Medical equipment give the physician a tax break for having a high tech instument in their practice.

    Congress should allow medical establishments certian tax deductions for having this equipment.

    Thirdly hospitals should have their own training facility for people who want to become MA’s HIM coders and Techs. This program should work with the technical schools and accreditted colleges to insure the highest level of education possible. Offer it to the students at a small out of pocket cost, but the student has to sign a contract stating he/or she will work for the practice for five years. This may ensure a decrease in unemployment.

    If all of this legistration is going to go through have fun getting your next physical at the post office.

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