decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 2 (February)
Medicare postpones controversial ‘anti-markup’ provision until 2009
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Article Overview
This article covers a CMS Medicare payment rule change affecting physician practices, especially cardiology and diagnostic imaging. It explains that most of the anti-markup provision was postponed until 2009, while selected components remained effective in 2008, and it discusses the policy context, the types of services affected, and the possibility of future clarifying guidance. The article is relevant to physicians, practice managers, and medical coders who follow Medicare physician fee schedule updates and billing policy changes.
Why This Topic Matters
The postponement changes the immediate Medicare billing environment for practices that provide diagnostic imaging and related services. Readers need to understand which parts of the rule were delayed, which stayed in force, and that CMS may revisit the issue with additional guidance.
Article Sections
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CMS postpones most of the anti-markup provision
Summarizes the Medicare rule change and the timing of CMS’s decision. It frames the update as a temporary delay affecting physician practices.
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Portions that remain in effect
Describes the parts of the policy that continue to apply in 2008 and identifies the general categories of services still affected. It also notes the effective date referenced by the rule.
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Impact on diagnostic imaging billing
Explains why cardiology and other physician practices were concerned about the broader rule and how the postponement affects imaging-related billing policy. It focuses on the practice-level implications of the CMS action.
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CMS clarification and possible future rulemaking
Notes CMS’s stated intent to study the issue further and consider additional guidance or a new proposed rule. This section addresses the policy review process rather than operational coding detail.
What You Will Learn
- The scope of a CMS delay affecting a Medicare payment policy
- Which portions of the policy continued to apply during the delay period
- How the change relates to diagnostic imaging services in physician practices
- What CMS indicated it may do next regarding clarification or rulemaking
Who Should Read This
- Physicians
- Practice managers
- Medical coders
- Billing staff
- Cardiology practices
- Radiology-related practices
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