decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 5 (May)
CMS prepares to launch new rules for diagnostic tests
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Article Overview
This article covers CMS’s updated anti-markup rules for diagnostic tests and how the new effective and implementation dates affect practices that furnish or bill for professional and technical components. It is aimed at physicians, practice managers, and coders who handle Medicare diagnostic test billing, especially in interventional and office-based settings. The discussion centers on reviewing existing arrangements, understanding when the rules may or may not apply, and recognizing the general compliance considerations tied to Medicare billing structure.
Why This Topic Matters
The article is relevant because Medicare’s revised anti-markup requirements can change how diagnostic test services are billed and how practices structure vendor or physician interpretation arrangements. For organizations that bill Medicare for diagnostic test components, understanding the timing and scope of the rule change is important for avoiding billing problems and aligning internal workflows.
What You Will Learn
- How CMS’s revised anti-markup rules affect billing for diagnostic test components
- Why practices may need to review existing professional and technical component arrangements
- What general compliance issues arise when diagnostic services are provided across different practice settings
- How the timing of the CMS update affects implementation planning
Who Should Read This
- Physicians
- Interventional practices
- Practice managers
- Medical coders
- Billing staff
- Compliance staff
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