CMS cracks down on testing self-referrals

CMS has proposed new rules that would limit the "in-office ancillary services" exception to federal self-referral law. Specifically, they're taking a closer look at the extent to which physicians may be taking excessive profit from a standard diagnostic services, particularly MRI, CT and PET scans. While federal law bans doctors from referring patients to outside facilities in which they have a financial interest, the rules make an exception for tests doctors perform on site or at a facility they lease full-time for the purpose. What concerns CMS, among other things, is that the outside facility is often run by contractors to the medical practice, and at times, the medical group can bill Medicare for more than it pays that outside contractor. The new CMS rules would attempt to limit opportunities for groups to pay a lower fee and collect a higher one for diagnostic services.

To get more detail on CMS's proposal:
- read this Wall Street Journal article (sub. req.)

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