October 2007 Newsletter

Medicare and Medicaid Reform Proposals – No Changes Targeting In-Office CT Scanning

 The Centers for Medicare and Medicaid Services (CMS) has proposed rule changes aimed at limiting self-referral abuses by physicians, but in-office CT scanning will not be affected by the proposals.   

The Medicaid Physician Fee Schedule (MPFS) changes proposed for 2008 include a tightening of the rules for “per-click” scanning payments with hospital/physician lease agreements.  The goal is to return these types of hospital/physician agreements back to their original intent of sharing healthcare costs and to avoid creating an incentive to over-scan.  The MPFS changes for 2008 also include limitations on the technical component mark-up when the TC is performed by an outside company.  The MPFS changes are scheduled to be enacted sometime in January 2008, although a delay of that date is expected.   

Other changes proposed for later in 2007 include changes to the current Stark self-referral regulations.  Known as Stark II Phase III, the proposal closes some loopholes regarding indirect compensation, changes the rules for an independent contractor physician working with a group practice, and clarifies the security interest held by a physician when selling to a hospital.  Stark II Phase III will go into effect December 4, 2007.   

The good news for physicians with their own point-of-care CT scanner is that none of the proposed rule changes are directed towards in-office CT imaging.  The in-office ancillary exception under Stark continues unchanged and will permit a physician to image patients on the physician’s own equipment in his or her office.   

If you have any questions concerning these changes, please contact Matt Jordan or Susie Vestevich at Xoran Technologies, Inc.