Medicare Compliance & Reimbursement

 Physicians will ring in 2011with a new patient notice requirement, if they provide advanced imaging (MRI, CT, or PET scans) under the Stark In-Office Ancillary Services exception.

As required by the Affordable Care Act, physicians self-referring a patient to an advanced imaging service must inform the patient in writing of their financial interest in the service. The disclosure also has to list nearby alternative suppliers where the patient could receive the imaging service. The requirement goes into effect on Jan. 1.

The final 2011 Medicare physician fee schedule rule finalized the disclosure mandate, says attorney Claire Turcotte, with the Dayton-Cincinnati, Ohio office of Bricker & Eckler. Centers for Medicare & Medicaid Services did, however, make some modifications in response to public comments about the burden associated with the disclosure requirements in the proposed physician fee schedule rule, she says.

Fewer alternatives: The proposed rule said physicians had to list 10 alternative suppliers as part of the disclosure, but in the final rule, CMS cut that number to five within a 25-mile radius of the physician's office, Turcotte notes.

The disclosure should minimally include each supplier's name, address, and telephone number, states the final rule.

Hospitals aren't included as alternative suppliers because they don't meet the Medicare definition of supplier, Turcotte says.

Key: "Patients aren't required to go to the alternative suppliers," adds Turcotte. "Once they receive the disclosure, they can still choose to get their imaging service at the physician's imaging location."

CMS also eased the documentation requirement somewhat, Turcotte says. Under the proposed rule, physicians had to get a patient to sign the disclosure form, which had to be maintained in the patient's medical record, she relays. However, "the final rule eliminated the signature requirement," although the rule does say that physicians need a way to assure that the patient received the disclosure.

"Probably the most bullet-proof way" to do that is to obtain the patient's signature on the full disclosure form -- or at least get patients to sign a form acknowledging that they received and read the disclosure, Turcotte advises. "Short of that," the physician could have a practice in place where the staff gives patients the disclosure to review. "Then someone in the practice can note the process was followed." The person could do that by documenting it in the medical record or by checking off that the disclosure was given as part of the patient visit, she says.

Resource: For more information, read pages 73443- 73447 of the final Medicare physician fee schedule ruleat online http://edocket.access.gpo.gov/2010/pdf/2010-27969.pdf.