• Physician Entities and Suppliers Performing Diagnostic Tests Must Enroll as IDTFs
  • July 30, 2008 | Author: Kevin P. Kimery
  • Law Firm: Waller Lansden Dortch & Davis, LLP - Nashville Office
  • The proposed 2009 Medicare Physician Fee Schedule, published in the Federal Register on July 7, 2008, includes a requirement that physicians and other suppliers which perform diagnostic tests must enroll as an Independent Diagnostic Testing Facility (IDTF) and be subject to a host of standards that could force substantial changes to their operations.

    Historically, physician entities that performed diagnostic tests had the choice to enroll in Medicare as a physician clinic, as an IDTF or, until recently, as both (dual enrollment). As CMS continued to heighten the performance standards for IDTFs, enrolling a physician entity as a physician clinic rather than an IDTF became more attractive. The enrollment process was as simple as checking a different box and providing substantially less information on the Medicare enrollment application than for an IDTF enrollment. What little guidance there was from CMS indicating when suppliers were “independent” and required to enroll as an IDTF was removed from Chapter 10 of the Medicare Program Integrity Manual in recent rounds of IDTF regulatory changes.

    Now CMS is proposing to require physicians and non-physician practitioners who are performing diagnostic testing services (except diagnostic mammography services) to enroll as IDTFs in addition to or instead of their physician enrollment. Since physician groups can generally bill for certain procedures that IDTFs cannot, some physicians may find it necessary to maintain both enrollments. Other suppliers which could submit all their claims under an IDTF enrollment may elect to drop the physician group enrollment entirely.

    CMS’s intent is to eliminate the option of allowing diagnostic suppliers to bypass the IDTF standards by enrolling as a physician group or similar category. Failure of these suppliers under the proposed rule to enroll as an IDTF could result in denial of claims or revocation of Medicare billing privileges.

    Physician groups forced to enroll as IDTFs would be required to meet all the IDTF standards, except as discussed below. For instance, they would be required to list all their technician personnel, interpreting physicians and supervising physicians, along with copies of these individuals’ credentials, on the CMS-855 enrollment form along with a complete list of CPT codes to be billed and equipment used for procedures. This information must be updated by additional CMS-855 filings as changes occur. The IDTFs would also be subject to an enrollment survey to ensure compliance with the IDTF standards. Physicians and non-physician practitioners required to enroll as IDTFs, however, would be exempt from some of the IDTF standards and would not be required to:

    • Maintain additional comprehensive liability insurance for each practice location
    • Maintain a formal clinical complaint process
    • Post IDTF standards
    • Maintain a visible sign posting business hours
    • Not share a practice location with another Medicare-enrolled entity

    With respect to the last item, a number of points are noteworthy. First, the release confusingly identifies the standard in question as the requirement to enroll each practice location separately. The regulatory cross-reference, however, is actually to the standard prohibiting space sharing of an IDTF with another Medicare supplier. This latter standard seems the appropriate standard for an exception in order to permit dual enrollment at a single location. Second, the prohibition on leasing or subleasing the IDTF operations or its practice location to another Medicare-enrolled individual or organization (“block-leasing”) would apply to such IDTFs. The effect would be to make the block-leasing prohibition apply to physician groups that are forced to enroll as IDTFs, whereas before they would not be covered by this requirement. For example, physician groups currently sharing diagnostic equipment with other physician groups would no longer be permitted to do so as soon as they become IDTFs.

    CMS is soliciting comments on, among other things, whether it should establish additional exceptions to the IDTF performance standards and whether the requirement to enroll as an IDTF should apply only to a subset of diagnostic procedures, such as more complex procedures or imaging services only.

    If implemented, the rule would be effective for enrolled suppliers as of Sept. 30, 2009 and for newly enrolling suppliers as of Jan. 1, 2009.