decisionhealth Newsletters, Answer Books - 2009 Issue 9 (September)
Diagnostic Testing / 2 factors decide whether anti-markup rules apply to your diagnostic tests
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Article Overview
This brief policy article discusses Medicare guidance related to purchased diagnostic testing services and the circumstances that determine whether anti-markup rules apply. It is aimed at physician practices, billing staff, and coders who handle diagnostic test payment arrangements and want to understand the general factors CMS uses in this area. The article focuses on the overall policy context, the setting in which services are performed, and the business relationship between the ordering practice and the entity performing the work.
Why This Topic Matters
Diagnostic testing payment rules can affect how a practice bills, manages purchased services, and reduces compliance risk under Medicare policy. Understanding the broad criteria discussed here helps revenue cycle and compliance teams assess whether a diagnostic testing arrangement should be reviewed more closely.
What You Will Learn
- The Medicare policy context for purchased diagnostic test components
- The general factors CMS uses to evaluate whether anti-markup rules may apply
- Why service location and business relationship considerations matter for diagnostic testing arrangements
- Who in a practice may need to review diagnostic testing billing relationships and compliance issues
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Revenue cycle staff
- Compliance staff
- Practice administrators
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