There have been many exciting developments in Health Care Law… here is a quick summary of the major changes affecting our clients! The Anti-Markup Rule (“AMR”). The Medicare anti-markup prohibition for testing will not apply to the technical component (“TC”) or professional component (“PC”) of a diagnostic test if: (i) the performing or supervising physician performs at least 75% of his/her professional services for the billing physician or other supplier;

OR

(ii) the TC and/or PC is performed by an employee or independent contractor physician in the same building where the office of the ordering physician or other supplier is located.

If neither test can be satisfied, the AMR will apply to the TC and/or PC of a purchased diagnostic test. Independent Diagnostic Testing Facilities (“IDTF”). Although the Centers for Medicare and Medicaid Services (“CMS”) proposed to  require all physician and non-physician practitioner organizations that furnish diagnostic tests to enroll as an IDTF…. CMS ultimately decided not to implement this regulation at this time.

Mobile IDTFs.

All mobile entities that “provide diagnostic testing services” must (i) enroll in Medicare; (ii) comply with the IDTF performance standards; and (iii) directly bill Medicare for their services. However, companies that provide only: (i) diagnostic testing equipment; (ii) non-physician personnel; or (iii) diagnostic testing equipment and non-physician personnel, do not have to comply with these standards!

The Florida Patient Bill of Rights and Responsibilities Act (“Rights Act”). A Health Care Provider (i.e., physician) or Health Care Facility (i.e., ambulatory surgical center) must provide the following to an uninsured patient prior to performing a non-emergency medical service:

  • a reasonable estimate of charges; and
  • information related to the Provider’s or Facility’s discount or charity policies.

The Provider/Facility may exceed the estimate based on patient care needs.

Health Care Clinic Establishment Permit (“Permit Act”). A group practice that is owned and operated by a P.A. or a P.L.L.C. must obtain a Health Care Clinic Establishment Permit to purchase prescription drugs. Each practice location must have a qualifying practitioner (i.e., M.D., D.O., ARNP, etc.) who is responsible for legal and regulatory compliance. A sole practitioner, however, may purchase prescriptions under his/her personal license.

If you would like additional details regarding this article or wish to discuss the impact of these changes to your organization, please contact Jonathan D. Fleece.

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