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CMS-1403-FC
would be simpler to not have any anti-markup provisions
beyond what existed prior to the CY 2008 PFS final rule
with comment period, but we remain convinced that
additional rulemaking is necessary to address the potential
for overutilization through unnecessary testing. Likewise,
we agree that it would be simpler to adopt the approach, as
suggested by one commenter, that we not allow any
reassignment of diagnostic testing services and, instead,
require direct billing, but, without studying that approach
further, we have concerns that doing so may unnecessarily
prevent nonabusive arrangements. Thus, the resulting rule
presents some complexity in order to both allow flexibility
for the industry while implementing statutory intent and
addressing our concerns of the potential for
overutilization and patient abuse. To some extent, we have
simplified the anti-markup provisions in §414.50 by
deleting superfluous references to purchased TCs and PCs as
bases for imposing an anti-markup payment limitation, for
the reasons discussed above and more fully below at
II.N.2.h.
Comment: A commenter recommended that we finalize a
combination of both Alternative 1 and Alternative 2, so
that in order for the anti-markup provision to not apply,
an employee or contractor physician should work solely for
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