Notice: This CMS-approved document has been submitted - Philips ...
Notice: This CMS-approved document has been submitted - Philips ... Notice: This CMS-approved document has been submitted - Philips ...
CMS-1403-FC conducts the TC, and notwithstanding the employment status of the supervising physician and the fact that the test is supervised in the office of the billing physician or other supplier; and (2) where the TC is conducted by a non- employee of the billing physician or other supplier and outside the office of the billing physician or other supplier, the TC nevertheless will not be considered a purchased test if the supervising physician is an employee or independent contractor of the billing physician or other supplier and performs the supervision in the office of the billing physician or other supplier. Several commenters offered support of the primary proposed definition of outside supplier. One such commenter also requested that the final rule make clear that, for anti-markup purposes only, the performing supplier with respect to the TC would be the physician who supervised the TC, even when the technician is not an employee of the billing physician or other supplier. One commenter supported the first alternative proposed definition of outside supplier. This commenter suggested that the physician organization should be permitted to mark up the TC only if the technician is an employee and the supervising physician is on-site and is also an employee of the billing physician or physician organization. One 494
CMS-1403-FC commenter supported adoption of the second alternative proposed definition. The commenter expressed its view that this definition provides sufficient flexibility to ensure that the anti-markup provisions will not be applied unless there is an inadequate relationship between the individual who performs or supervises the test and the billing entity. Response: As explained above at II.N.2., we are deleting from §414.50 purchased tests and interpretations from an “outside supplier” as separate bases for imposing an anti-markup payment limitation. After reviewing the comments, we have concluded that employing the concept of a purchased TC or PC as a separate basis for imposing an anti-markup payment limitation is unnecessary, redundant, and potentially confusing in light of our decision to finalize Alternative 1 and to allow arrangements that do not meet the requirements of Alternative 1 to avoid application of the anti-markup provisions if they meet, on a case-by-case basis, the requirements of Alternative 2. If we were to adopt any of our proposals for the definition of “outside supplier,” it would mean we would effectively impose an anti-markup payment limitation on some arrangements that meet the “substantially all” services requirement of Alternative 1. We believe that a physician who performs “substantially all” of his services through a 495
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<strong>CMS</strong>-1403-FC<br />
conducts the TC, and notwithstanding the employment status<br />
of the supervising physician and the fact that the test is<br />
supervised in the office of the billing physician or other<br />
supplier; and (2) where the TC is conducted by a non-<br />
employee of the billing physician or other supplier and<br />
outside the office of the billing physician or other<br />
supplier, the TC nevertheless will not be considered a<br />
purc<strong>has</strong>ed test if the supervising physician is an employee<br />
or independent contractor of the billing physician or other<br />
supplier and performs the supervision in the office of the<br />
billing physician or other supplier. Several commenters<br />
offered support of the primary proposed definition of<br />
outside supplier. One such commenter also requested that<br />
the final rule make clear that, for anti-markup purposes<br />
only, the performing supplier with respect to the TC would<br />
be the physician who supervised the TC, even when the<br />
technician is not an employee of the billing physician or<br />
other supplier.<br />
One commenter supported the first alternative proposed<br />
definition of outside supplier. <strong>This</strong> commenter suggested<br />
that the physician organization should be permitted to mark<br />
up the TC only if the technician is an employee and the<br />
supervising physician is on-site and is also an employee of<br />
the billing physician or physician organization. One<br />
494
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