Health Law Attorney Blog

A bill introduced in the Senate on August 5, 2010 would set forth minimum credentialing standards for medical personnel who "perform or plan" medical imaging or radiation therapy procedures. The Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act, introduced by Sen. Harkin (D-IA) and Sen. Enzi (R-WY) responds to concerns that procedures like x-rays, CT scans, and MRIs are increasingly being performed by personnel without adequate training, and would go into effect in 2013. Currently, standards vary from state to state; the CARE Act isn't meant to supplant or diminish more stringent standards that exist in some states. In addition, the Bill creates a grandfathering process for technicians who currently provide medical imaging or radiation therapy but don't meet the new education standards. It also establishes alternative standards for rural and underserved populations.

Given broad-based support, according to a press release from Sen. Harkin, the Bill is expected to pass this year.

Continue reading "CARE Act Would Create Credentialing Standards for Medical Imaging Personnel" »

Effective May 1, 2010, physicians, IDTFs and other Part B Suppliers furnishing Non-invasive Vascular Testing in Michigan must comply with new training and certification requirements. In part, the policy, as set forth in a new LCD, states:

A. Training and Certification

1. The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill, and experience of the technologist and interpreter. Consequently, the physician performing and/or interpreting the study must be capable of demonstrating documented training and experience and maintain any applicable documentation. A vascular diagnostic study may be personally performed by a physician or a technologist.

"The GAO Report to Congressional Committees entitled Medicare Ultrasound Procedures. Consideration of Payment Reforms and Technician Qualifications Requirements states that "Findings from several peer-reviewed studies, the Medicare Payment Advisory Commission, and ultrasound-related professional organizations support requiring that sonographers either have credentials or operate in facilities that are accredited, where specific quality standards apply. In some localities and practice settings, CMS or its contractors have required that sonographers either be credentialed or work in an accredited facility." (GAO-07-734)

2. All non-invasive vascular diagnostic studies must be performed under at least one of the
following settings:

a. performed by a physician who is competent in diagnostic vascular studies or under the general supervision of physicians who have demonstrated minimum entry level competency by being credentialed in vascular technology, or
b. performed by a technician who is certified in vascular technology, or
c. performed in facilities with laboratories accredited in vascular technology.

3. One or more technologists in each vascular laboratory must be certified by a credentialing board recognized by the Intersocietal Commission for Accreditation of Vascular Laboratories (ICAVL) or the National Council for Certifying Agencies (NCCA) or the International Standards Organization (ISO) 17024).

4. Laboratories may be certified by the Intersocietal Commission for the Accreditation of Vascular Laboratories. Certification of the laboratory itself supersedes the requirement for certification of individual technologists.
If a certified technologist supervises technologists who are not certified, the certified RVT must: provide direct supervision; and sign the record of the test and attest to the quality of the examination.

Physicians and Independent Diagnostic Testing Facilities--including mobile facilities--must ensure that their technicians, medical directors, and supervision protocols meet the above guidelines, and that billing documents reflect that. For assistance ensuring compliance with these and other rules governing IDTFs, please contact Adrienne Dresevic, Esq. or Carey F. Kalmowitz, Esq. at (248) 996-8510. You can also find additional information on the HLP's specialty page for Diagnostic Imaging Arrangements.

Effective March 15, 2010, pursuant to CMS's update to the Medicare Claims Processing Manual addressing "Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Anti-Markup Payment Limitation", among other actions, The Centers for Medicare and Medicaid Services ("CMS") has effectively eliminated an Independent Diagnostic Testing Facility's ("IDTF's") or radiology group's ability to bill its local carrier (the "MAC") for interpretations performed by out-of-state physicians (the "CMS Change Request"). Rather, by operation of these Medicare changes and Medicare's claims processing system, these imaging suppliers must now either take reassignment and bill the MAC in the interpreting physician's jurisdiction (if and only if they are able to establish a practice location in that MAC jurisdiction for enrollment purposes), or have the interpreting physician bill directly for such services.

Unfortunately, for a substantial number of imaging suppliers (such as radiology groups and IDTFs, which are not subject to the anti-markup rule) that rely upon out-of-state teleradiology arrangements, according to our discussions with senior officials at CMS, until the agency publishes guidance to redress this issue, the only way to ensure payment by CMS of claims associated with these out-of-state interpretation services is to have the interpreting physician bill directly for his/her service. The only other option available for imaging suppliers is to accept reassignment from the out-of-state interpreting physician; however, this will require that the imaging supplier must be eligible to enroll in the out-of-state MAC jurisdiction. Notably, the issue remains unclear whether an imaging supplier will be able to enroll in the other jurisdiction if the supplier does not have a practice location in such jurisdiction. CMS has stated that a supplier without a practice location established in the jurisdiction will not be accepted during the enrollment process. During our discussions with CMS, agency officials indicated that they intend to issue further clarification on these issues. Imaging suppliers whose business operations are adversely affected by this recent CMS Change Request should remain alert for a future guidance on this issue by CMS in the form of another Change Request.

Continue reading "CMS's Deletion of "Purchased Interpretations" Causes Problems for Certain Out-of State teleradiology arrangements: Imaging Centers Billing for out-of-State interpretations can Expect Claim Denials " »

Last week, the OIG released it's Compendium of Unimplemented Recommendations that "consolidates significant unimplemented monetary and nonmonetary recommendations addressed to the Department of Health & Human Services (HHS) to provide information to interested parties about outstanding recommendations...." While these have not been implemented, it is something we want our clients and readers to be aware of. It shows the direction the OIG is going and where it is focusing its efforts. Some relevant recommendations are below:

Hospices:
1. Due to the high number of hospices that were overdue in their certifications and due to the almost 50% of hospices having health deficiencies, the OIG recommends that CMS adopt statutory or regulatory changes to establish requirements for the frequency of certifications for hospice performance and for enforcing the remedies for a hospice's poor performance.
2. The OIG recommends that CMS strengthens its monitoring practices of hospice claims to ensure that they are properly submitted.

Home Health Agencies:
1. Due to the high levels of medically unnecessary care and fraudulent billing, the OIG recommends that CMS revise its regulations to require physicians to examine Medicare beneficiaries prior to ordering home health services.
2. For those HHAs performing poorly, the OIG recommends that CMS adopt and impose sanctions (besides termination from Medicare) to improve the quality of care.

Laboratory and Imaging Services:
1. To prevent over-utilization of laboratory testing, the OIG recommends that CMS reinstate beneficiary co-insurance and deductibles for lab tests.
2. The OIG recommends that CMS pursue legislation to set accurate and reasonable payment rates for lab tests as the carrier rates for nearly all lab tests varied.
3. Because few counties account for a large percentage of the Part B spending on ultrasound and because 20% of claims raised concern about whether or not they were appropriate, OIG recommends that CMS continue to monitor ultrasound claims to reduce Medicare's vulnerability to questionable ultrasound claims.

Again, these are merely recommendations and have not been implemented. However, they are useful in seeing where the OIG is looking to make changes and what kinds of changes we can expect from CMS in the future. We will continue to keep you apprised of any updates and regulatory changes as they develop.

Continue reading "OIG Releases Compendium of Unimplemented Recommendations" »