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CMS-1403-FC
tenens arrangements could be avoided through requirements
for these arrangements in the Medicare Claims Processing
Manual, 100-04, Chapter 1, §30.2.11. One commenter stated
that, provided that locum tenens physicians satisfy
Medicare’s requirements governing the use of and billing
for such physicians, the anti-markup payment limitation
should not apply to tests performed or supervised by such
physicians.
One commenter enumerated additional circumstances in
which group practice physicians provide services to or
through entities other than their primary group
affiliation. These circumstances included: (1) covering
for another practice while it recruits to replace a retired
or deceased physician; (2) providing specialty services at
hospitals or primary care clinics in areas (often rural,
but not always) that would otherwise not have those
specialties available and convenient to patients; and (3)
providing specialty services to a different practice that
has only a part-time need for the service.
Another commenter noted the potential for situations
where a non-radiology practice contracts with a radiologist
as a locum tenens physician to circumvent the anti-markup
provision. The commenter recommended that we exclude only
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