Medicare Clarifies Point of Service Rules

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The Centers for Medicare and Medicaid Services has clarified that “point-of-service” designation for the professional component of Medicare services should reflect where the examination was performed.

In other words, the "point-of-service" for both the technical component and the professional component should be the same, regardless of whether the image was read from a remote location.

Although industry practice had been to report the "point-of-service" as where the examination occurred, CMS never had a real firm definition of place of service, says Mike Mabry, RBMA executive director. Definitions also differed for primary care doctors, surgeons or radiologists.

“Teleradiolgoy complicated things even further,” Mabry says. “The good news is we have a common point of service that’s consistent with how the radiology industry sees it.”

The clarification came after Medicare administrators worked with the Radiology Business Management Association and other industry representatives.

Previously, CMS guidelines were unclear on the subject. Medicare issued guidance in 2009 that more muddied the waters than did any good, stating that "point-of-service" should reflect where services were provided. Registering different locations could confuse enrollees and also make it more difficult to track medical records in some cases.

"There's still some work to be done and some questions out there, but it’s an improvement," Mabry says.