Earlier this year, the Centers for Medicare & Medicaid Services (“CMS”) issued regulations which prohibited many Independent Diagnostic Testing Facilities (“IDTFs”) (i.e., imaging centers) and physician arrangements (specifically block leasing and shared ancillary models, both of which are common in the health care industry). Thankfully, CMS rescinded this law and apologized for “any inconvenience this may have caused”. What does this mean for the future? We predict that changes are still coming.
Current law permits the following:
- Physicians who perform and read imaging studies in their office can bill globally for both the technical and professional portions of the scans;
- Physicians who perform imaging studies in their office and use an off-site independent contractor radiologist can bill only for the technical portion of the scans, with the teleradiologist billing directly for the professional portion of the scans; and
- Physicians who perform imaging studies in their office and use an independent contractor radiologist to read the scans in the physician’s office can bill globally for both the technical and professional portions of the scans.
Other proposed regulatory changes will continue to allow options 1 and 2, but will prohibit option 3. If these changes become final, physicians that bill for the technical component of the imaging studies would have two choices:
(1) perform the professional interpretations directly through employed physicians; or (2) permit an independent radiologist to perform and bill separately for the professional component of the service.
Bottom line, the current climate in CMS places all diagnostic imaging arrangements under attack. Combined with the reimbursement cuts under the Deficit Reduction Act, the environment is historically tough.
What can be done today?
- Before entering into new arrangements or renewing current ones, providers should carefully review and negotiate unwinding provisions in the event that future rules impact current arrangements.
- Analyze how these potential changes could change your practice if implemented and begin to develop a response strategy.
- Stay in touch with us! We will strive to keep you informed and prepared.
- Remember that many regulatory changes bring future opportunities, yet to be identified.
