New Anti-Markup Rule Revisions for Diagnostic Testing Billing

Avoiding Medicare Exclusion, False Claims Liability, and CMS Penalties

2009 Physician Fee Schedule Final Rule Effective January 1

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

Conducted on Wednesday, January 28, 2009

Course Materials

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
Paul F. Danello
Polsinelli Shalton Flanigan Suelthaus

He focuses on corporate, financing and government regulatory matters for the health care industry. He has provided...  |  Read More

Donald H. Romano
Donald H. Romano
Arent Fox

He focuses on physician self-referral (Stark) anti-kickback matters and Medicare reimbursement issues affecting...  |  Read More

E. Michael Flanagan
E. Michael Flanagan

Polsinelli Shalton Flanigan Suelthaus

He focuses on healthcare regulatory matters affecting providers. He helps providers understand and comply with the...  |  Read More

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