Anti Markup Rule Pathology

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Nov 13, 2007  · New Anti-markup Rules May Curb Pathology Profiting Surgical centers that set up off-site laboratories to provide pathology services will have a harder time profiting from such arrangements under new anti-markup rules announced last week.

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Surgical centers that set up off-site laboratories to provide pathology services will have a harder time profiting from such arrangements under new anti-markup rules announced last week. Many urology and gastroenterology practices have established off-site labs known as "pods" or "condos" that employ part-time pathologists and let the surgeon serve as a billing group.

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CMS included this "anti-markup rule" as part of its final 2008 physician fee schedule for all diagnostic services, as defined in physician self-referral regulations (also referred to as the Stark Law), but postponed implementation of the rule for all of the services other than anatomic pathology.

Nov 11, 2008  · On October 30, 2008, CMS issued the final anti-markup rule for diagnostic tests, after one year of uncertainty on the scope and application of the rule.

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Oct 01, 2010  · This is a step in the right direction, but the new rules should be expanded to include other services covered by the anti-markup rule and the Stark Law’s In-Office Ancillary Services Exception, such as anatomic pathology. CMS revised the anti-markup rule in 2007 in an effort to deter abusive billing of pathology services.

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Jul 17, 2008  · CMS concluded that these pathology laboratory arrangements, in particular, the "centralized building" approach, abuse the Stark in-office exception and CMS decided to prohibit the arrangements by adopting a site-of-service test under the Anti-Markup Rule that effectively carves all diagnostic testing arrangements out of the Stark in-office exception, unless the diagnostic testing is.

Jan 01, 2009  · The revised anti-markup rule provides greater flexibly than the 2008 MPFS rule. With the complexity of many diagnostic-service arrangements, however, many groups may need to revise and unwind current agreements by January 1, 2009, or subject themselves to the payment limitations of the anti-markup rule.

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For example, the College of American Pathologists has been out front to ensure that reforms include language that accounts for the kinds of quality metrics actionable by diagnostic practices, such as.

Jan 28, 2009  · The new revisions, effective January 1, adopt a two-step approach to determining when the anti-markup payment limitation applies to billing for diagnostic tests. Failure to comply with the anti-markup rule could result in sanctions, false claims liability and exclusion from the Medicare program.

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obbying efforts by the American Society for Clinical Pathology and other pathology trade groups to outlaw in-office pathology labs have fallen on deaf ears. The 2011 Physician Fee Schedule Proposed Rule released by the Centers for Medicare and Medicaid Services on June 25.

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Nov 13, 2007  · New Anti-markup Rules May Curb Pathology Profiting Surgical centers that set up off-site laboratories to provide pathology services will have a harder time profiting from such arrangements under new anti-markup rules announced last week.

Nearly half of the states in the nation have laws that limit the practitioner-laboratory relationship by regulating re-billing, and both federal and state governments have some form of anti-kickback, Stark, or Stark-like law on the books. Misconceptions abound regarding exactly.

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However, CMS did move forward and finalize proposed changes regarding anti-markup provisions for diagnostic tests. These changes were to be made effective as of January 1, 2008. But in a surprising move, on December 28, 2007, CMS delayed the effective date of many of the new anti-markup provisions until January 1, 2009.

Mar 08, 2009  · The way the anti-markup rules work now, if a pathologist interprets an 88305 on site for a urology group, for example, the group could pay the pathologist less than the full Medicare allowable and then bill Medicare for the full amount, says Wood, of McDonald Hopkins LLC, Dennis, Mass.

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The only constant is change is an apt mantra for the imaging industry over the past several years. For the second time in two years, CMS has proposed comprehensive changes in the anti-markup provision of the purchased diagnostic test rule (AMR) in the Medicare Physician Fee Schedule (MPFS) regulations. The most significant of the 2008 finalized

Sep 13, 2010  · Instead, the anti-markup rule requires only that the supervision be provided by a physician, any physician, who is part of the billing practice.