October 23, 2006—Today’s Wall Street Journal takes an in-depth look (registration required) at the Medicare Physician Fee Schedule changes proposed by the Centers for Medicare and Medicaid Services (CMS) regarding self-referral rules. CMS is considering tightening the in-office ancillary services exception in light of steep increases in Medicare expenditures for medical imaging; spending on these services has gone up 20% a year since 1999, and totaled $7 billion in 2005.
Axis Imaging News reported on the proposed changes to the reassignment rule governing arrangements between physicians when two different groups split the global billing. The new rules proposed in August could go into effect as early as November, the Journal reports, and serve to restrict some financial arrangements related to the in-office ancillary services exception, which allows physicians in group practices to refer patients to the group’s offices for tests, or to a separate facility leased by the group for the purpose of performing tests.
Acting CMS Administrator Leslie Norwalk says some providers are profiting from a loophole in the exception by billing Medicare for a higher rate than the group pays to conduct the tests. The new rules would restrict certain financial arrangements and crack down on pathology pod labs. “There are times when self-referral is appropriate and times when this has been abused,” Norwalk told the Journal.
CMS has received over 2,300 comments on the proposed rules. Critics say the rules are too broad and could limit patient access to testing services.
—Cat Vasko
