New Anti-Markup Rule Revisions for Diagnostic Testing Billing

Avoiding Medicare Exclusion, False Claims Liability, and CMS Penalties

Recording of a 90-minute CLE webinar with Q&A

Conducted on Wednesday, January 28, 2009
Recorded event now available

This seminar will review the new anti-markup revisions in the 2009 Physician Fee Schedule Final Rule, explain the rule's relationship to the Stark Law, and offer best practices for providers to ensure compliance.


The Centers for Medicare and Medicaid Services (CMS) published the 2009 Physician Fee Schedule Final Rule in the November 19th Federal Register. The revised Fee Schedule makes several important changes to the anti-markup rule for diagnostic tests.

The new revisions, effective January 1, adopt a two-step approach to determining when the anti-markup payment limitation applies to billing for diagnostic tests. Failure to comply with the anti-markup rule could result in sanctions, false claims liability and exclusion from the Medicare program.

Legal advisors for healthcare providers must understand the new rules to ensure their clients and companies are in compliance to avoid penalties and sanctions — and to maximize Medicare reimbursements.

Listen as our panel of healthcare attorneys reviews the new anti-markup revisions, explains the rule's relationship to the Stark Law, and offers their perspectives and best practices for providers to ensure compliance.


  1. Anti-markup rule — overview
    1. Purpose of rule
    2. Application
  2. Revisions to anti-markup rule
    1. Shared practice requirement/“substantially all” test
    2. Site-of-Service requirement/”same building” test
    3. Billing limitations
    4. Relationship to Stark Law’s in-office ancillary services exception
  3. Compliance strategies


The panel will review these and other key questions:

  • How will the revisions to the anti-markup rule affect billing practices for diagnostic testing?
  • What is the relationship between the new anti-markup rule revisions and the Stark Law's in-office ancillary services exception?
  • What do healthcare providers need to do now to ensure they are in compliance with the new rule?


Paul F. Danello, Shareholder
Polsinelli Shalton Flanigan Suelthaus, Washington, D.C.

He focuses on corporate, financing and government regulatory matters for the health care industry. He has provided fraud and abuse counseling and developed corporate compliance plans for providers.

Donald H. Romano, Partner
Arent Fox, Washington, D.C.

He focuses on physician self-referral (Stark) anti-kickback matters and Medicare reimbursement issues affecting hospitals, physicians and other providers. He was previously the director of the division at the Centers for Medicare and Medicaid Services (CMS) responsible for Stark policy, including the revisions to "under arrangements" and "per click" leases.

E. Michael Flanagan
Polsinelli Shalton Flanigan Suelthaus, Washington, D.C.

He focuses on healthcare regulatory matters affecting providers. He helps providers understand and comply with the myriad federal and state regulations affecting their operations. With substantial experience in defending clients in federal an state investigations, he prefers the preventive approach of reviewing a proposed course of action for its potential fraud risks.


CLE On-Demand - Streaming Audio

Includes recorded streaming audio of full program plus PDF handouts.

On-demand is the only recorded format recognized for CLE credits in DE, IN, KS, LA, MS, NC, OH, OK, SC, TN, VA, WI.

AK, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN*, KS, KY, LA, ME, MN, MO, MT, NC, ND, NH**, NJ, NM, NV, NY, OH*, OK, OR, PA, SC, TN, TX, UT, VA, VT, WA, WI, WV, WY (Note: Some states restrict CLE eligibility based on the age of a program. Refer to our state CLE Map for additional information.)

*Only available for attorneys admitted for more than two years. For OH CLE credits, only programs recorded within the current calendar year are eligible - contact the CLE department for verification.

**NH attendees must self-determine if a program is eligible for credit and self-report their attendance.

CLE On-Demand Audio $297.00

How does this work?

Recorded Event

Includes full event recording plus handouts.

Strafford is an approved provider and self-study CLE credit is available in most states.

AK, AZ, CA, CO, CT, FL, GA, HI, IA, ID, IL, KY, ME, MN, MO, MT, ND, NJ, NM, NY, OR, PA, TN, TX, UT, VT, WA, WV, WY (Note: Some states restrict CLE eligibility based on the age of a program. Refer to our state CLE Map for additional information.)

Strafford will process CLE credit for one person on each recording.

Additional copies of a recording can be purchased at a discount. Please call Strafford Customer Service toll-free at 1-800-926-7926 ext 10 or email to place your order.

Recorded Audio Download (MP3) $297.00

How does this work?

Program Materials

Requires Adobe Reader 8 or later. Download Acrobat FREE.

Program Materials

Requires Adobe Reader 8 or later. Download Acrobat FREE.

or call 1-800-926-7926

CLE Credits

Many states grant CLE credits for on-demand streaming audio programs and recorded events. Our programs are pre-approved in many states. Refer to our state CLE map for state-specific information.

or call 1-800-926-7926

Customer Reviews

I appreciated that the speakers had opinions and ideas to share beyond what is available in print.

Burton Wagner

Reinhart Boerner Van Deuren

Very concise - provided what was needed, yet also included many examples, thoughts and ideas.

Ron Keith

Skilled Care

The teleconference was efficient with a well-focused agenda. The speakers really seem to know the material and communicated it clearly.

Owen Hughes


The program included very informative information on an important subject.

Jamie L. Webb

Baker Manock & Jensen

The speakers were well prepared and were able to explain the information in a clear and concise manner.

Ayala Schwartz

Columbia University Clinical Trials Office

or call 1-800-926-7926

Health Law Advisory Board

Lowell C. Brown


Arent Fox

Jennifer L. Evans



Ryan S. Johnson


Fredrikson & Byron

Gina M. Kastel


Faegre Baker Daniels

Karen S. Lovitch


Mintz, Levin, Cohn, Ferris, Glovsky and Popeo

David A. Manko


Proskauer Rose

John J. Miles

Senior Counsel

Baker Donelson

C. Elizabeth O'Keeffe


Wyatt, Tarrant & Combs

J. Peter Rich


McDermott Will & Emery

Donald H. Romano

Of Counsel

Foley & Lardner

Judith A. Waltz


Foley & Lardner

John R. Washlick


Buchanan Ingersoll & Rooney

Jesse A. Witten


Drinker Biddle & Reath

or call 1-800-926-7926

Our Guarantee

Strafford webinars are backed by our 100% Unconditional Money-Back Guarantee: if you are not satisfied with any of our products, simply let us know and get a full refund. For more information regarding complaints and refunds, please contact us at 1-800-926-7926 ext 10. Complaints regarding this program can be submitted via the course evaluation found in the “Thank you” e-mail at the end of the course.