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  • APTA Urges MedPAC to Reconsider Self-Referral Exception

    Physical therapy services are not essential to diagnosis, and thus should be removed from the in-office ancillary exception to the Stark II physician self-referral law, APTA told the Medicare Payment Advisory Commission (MedPAC) this week at a meeting in which the commission introduced 4 new draft recommendations that aim to improve payment accuracy and appropriate use of ancillary services.

    The 4 recommendations, which focused on imaging and not physical therapy, included packaging and bundling payment for services, reducing the professional component payment for imaging studies done in the same session, reducing payment rates for imaging and other diagnostic tests done by self-referring physicians, and requiring prior authorization for physicians who order significantly more advanced imaging than their peers.

    APTA urged the commission to go further with its draft recommendations in the public comment period of the MedPac meeting. Because the in-office ancillary exception creates physician-owned physical therapy, APTA recommended that MedPAC eliminate those services that are not integral to diagnosis, such as physical therapy, from the exception. APTA also reminded the commission that physical therapy services provided in entities owned by physicians result in higher utilization and higher costs. Therefore, the association emphasized, extending a self-referral law exception to only those services integral to diagnosis helps to achieve the goal of payment accuracy and appropriate use of ancillary services.

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