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

CMS-1403-FC
the Alternative 2 approach by clarifying that the
performing physician must be an employee or independent
contractor of the billing physician or other supplier
(which has enabled us to delete the references to purchased
tests from an outside supplier.) Thus, billing physicians
and other suppliers may satisfy the Alternative 1
“substantially all” professional services approach or, on a
case-by-case basis, the Alternative 2 “site-of-service”
approach in order to avoid application of the anti-markup
payment limitation. We believe that complying with either
approach will address our concerns regarding potential
overutilization and other abuse by establishing a
sufficient nexus with the billing entity.
e. Exception for physician organizations that do not have
any owners who have the right to receive profit
distributions
Comment: We proposed an exception to the requirement
that diagnostic testing be performed in the “office of the
billing physician or other supplier” in order to avoid
application of the anti-markup payment limitation. We
proposed that (except for the purchase of a TC from an
outside supplier) the anti-markup provisions would not
apply to diagnostic tests ordered by a physician in a
physician organization that does not have any owners who
472