What is anti-Markup Rule?

What is anti-Markup Rule?

The Anti-Markup Rule is a payment limitation imposed on certain Medicare Part B diagnostic services performed by a physician who does not “share a practice” with the billing provider. In order to determine whether the physicians “share a practice,” one of two alternative tests must be met.

What is anti-markup payment limitation?

The anti-markup payment limitation will apply in cases where a physician does not meet the criteria for satisfying the ‘substantially all services’ test or the ‘site of service’ test defined below.

Does the anti-Markup Rule apply to hospitals?

Thus, as long as the Performing Physician is not providing more than 25 percent of his or her professional services as a locum tenens physician or other arrangements (i.e., part-time or moonlighting at a hospital) the anti-markup payment limitations will not apply.