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CMS-1403-FC
Response: As finalized, any physician (that is,
regardless of employment status or whether or she is an
owner of the billing entity) who performs “substantially
all” (at least 75 percent) of his or her professional
services for a billing physician or other supplier will be
deemed to share a practice with that billing physician or
other supplier.
d. Alternative 2 (“site-of-service”)
Comment: One commenter opposed our reproposal of the
existing “site-of-service” approach for determining whether
the physician performing or supervising the TC or PC of a
diagnostic test shares a practice with the billing
physician or other supplier, asserting that it will do
little to stifle the growth of self-referral in lab
arrangements. According to the commenter, this alternative
focuses only on where the test is performed and not by
whom, and, thus, specialty practices could profit from
their referrals simply by bringing “pod labs” in-house to
the location where the group provides physician services.
The commenter advocated for the rule to require clearly a
greater connection and integration between the performing
physician and the practice before the practice can profit
from lab tests ordered by physicians in the group.
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