Getting paid: CMS clarifies anti-markup provisions

Why This Topic Matters

It helps practices understand CMS payment policy changes that can affect billing workflows, reimbursement, and compliance for diagnostic testing services.

Article Sections

1. Anti-markup rule overview

   Introduces CMS’s policy framework for diagnostic testing services and the broad circumstances that trigger the anti-markup provisions.

2. What are the limits?

   Summarizes the general payment-limit framework described by CMS and the situations in which the rule may apply.

3. How CMS defines sharing a practice

   Explains the general criteria CMS uses to determine when a performing physician is considered to be sharing a practice with the billing physician or supplier.

4. CMS examples

   Reviews illustrative scenarios CMS published to show different practice arrangements and testing locations.