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

CMS-1403-FC
with comment period, the profit incentive to order
unnecessary diagnostic tests remains if the billing
physician or other supplier may markup the PC of the test
(72 FR 66315). Moreover, and as also discussed in the
preamble of the CY 2008 PFS final rule with comment period,
section 1842(b)(6) of the Act authorizes us, but does not
command us, to allow reassignment of physician services,
including the PC of a diagnostic test (72 FR 66309). At
this time, we are not prohibiting reassignment of PCs and
instead requiring direct billing, but we are imposing
restrictions on the reassignment of PCs. That is, a PC
that is reassigned by the performing physician to the
billing physician or other supplier that ordered the PC may
not be marked up by the billing physician or other
supplier, unless the performing physician shares a practice
with the billing physician or other supplier. If a
physician or other supplier that orders a PC does not find
that billing for the PC under an arrangement that is
subject to the anti-markup provisions is profitable or
financially worthwhile, that physician or other supplier is
free to not accept reassignment and instead have the
performing physician or other supplier bill directly for
the PC.
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