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CMS-1403-FC
One commenter questioned whether there is evidence
suggesting tax-paying medical groups behave, or are likely
to behave, in a manner substantially different than tax
exempt medical groups. The commenter also stated that it
was unaware of any instances where the Medicare program
differentiates policies based solely on institutional mode
of ownership, incorporation, or tax status, and questioned
if we have statutory authority to create such an exception
based on type of ownership.
Response: We have determined that it is not necessary
to finalize an exception for diagnostic tests ordered by a
physician in a physician organization that does not have
any owners who have the right to receive profit
distributions. By finalizing both proposed alternative
approaches to avoiding application of the anti-markup
payment limitation we believe that our concern that the
Alternative 2 approach could hinder arrangements involving
nonprofit multi-specialty groups that have campus-based
treatment facilities (and, thus, do not perform diagnostic
testing in the same building where patients are seen)
largely becomes moot, as most such arrangements should be
able to be structured (or are already structured) to meet
the requirements of either the Alternative 1 or Alternative
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