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CMS-1403-FC
Response: We recognize the potential for arrangements
that may be troublesome to be restructured so that the
diagnostic testing is performed in the same building as
where the testing is ordered; however, we are also
concerned that adopting Alternative 1 without leaving in
place the site-of-service approach of §414.50 (which we
reproposed as Alternative 2) may unnecessarily disrupt some
arrangements that do not appear problematic to us. We will
continue to monitor arrangements and may propose further
changes if necessary. Also, we continue to examine
industry use of the in-office ancillary services exception
of the physician self-referral rules, and may propose
changes to that exception in a future rulemaking.
Comment: Some commenters did not believe that site-
of-service distinctions are relevant to determining the
appropriate scope of section 1842(n) of the Act. According
to the commenters, it should not matter if physicians are
in a bona fide group practice that has one building or ten,
and, if ten, the particular geographic configuration of the
ten buildings should not matter. The commenters questioned
the legal or policy justification for applying different
site-of-service rules for purposes of the anti-markup
provision than those that are employed in the physician
self-referral regulations. Of particular concern for these
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