Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
numerical test for the physician self-referral rules.
Thus, for purposes of determining whether the anti-markup
provisions apply, the performing physician (that is, the
physician supervising the TC or performing the PC, or both)
is considered to share a practice with a physician group
for which he or she provides at least 75 percent of his or
her professional services -- even if the physician works
for one or more billing physician groups or other health
care entities. The final rule provides at revised
§414.50(a)(2)(ii) that the “substantially all” requirement
is satisfied if the billing physician or other supplier has
a reasonable belief at the time it submits a claim that:
(1) the performing physician has furnished substantially
all of his or professional services through the billing
physician or other supplier for the period of 12 months
prior to and including the month in which the service was
performed; or (2) the performing physician is expected to
furnish substantially all of his or her professional
services through the billing physician or other supplier
during the following 12 months (including the month the
service is performed).
We believe that our modification to the proposal for
Alternative 1 will satisfy the concerns regarding locum
tenens arrangements (and part-time and other on-call or
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