CMS looks to crack down on abuses to medical test self-referrals

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The U.S. Centers for Medicare and Medicaid Services has proposed tough rules to help prevent physician self-referral abuses, the Wall Street Journal reports. The rules stem from concerns that unneeded and costly diagnostic exams ordered by doctors are pushing up healthcare costs and lining the pockets of some doctors who are unethically cashing in. The changes could go into effect by as early as next month. One change would block a doctor for billing a higher amount for an MRI scan, for example, than it would cost to provide or have someone else provide, the Journal reports.

Current regulations on the books prohibit doctors from referring patients to centers and labs in which they have a vested financial interest, though definite loopholes exist. The rules CMS has proposed would block several common loopholes. One in particular is known as the “in-office ancillary services” exception. While this exception would remain, CMS would put tighter controls on how the procedures are billed. For example, group practices with in-house MRI machines would not be allowed to bill the cost of a part-time radiologist brought in to read the images. Additionally, radiologists would be asked to bill for each scan individually, thus reducing the chance that groups could make money on differences between what the hired radiologist was paid and what is collected from Medicare, the Journal reports.

Since the new rules were first introduced in August, CMS has received 2,300 comments regarding the proposed changes that are currently under review, the Journal reports.

Some have definitely come out swinging against the rule-change proposal. “This is too broad,“ said Andrew Whiteman, vice president for the National Electrical Manufacturers Association, which represents medical imaging equipment vendors. “Medicare needs to be more concise. If there are specific concerns, those should be addressed,” the Journal reports.