On January 26, 2007, CMS issued Medicare Program Integrity Manual Transmittal 187, which would have made significant changes to Medicare’s Independent Diagnostic Testing Facility (IDTF) enrollment rules. The transmittal – which included several significant policy changes that were not included in the 2007 Medicare Physician Fee Schedule final rule – would have had a dramatic impact on the ownership and operations of diagnostic imaging centers and other types of IDTFs.  CMS,however, rescinded the transmittal prior to its implementation date of February 26, 2007.

The following were some of the issues with the new IDTF enrollment requirements:

1. There was a prohibition against IDTFs sharing space and equipment with other IDTFs and suppliers. This may actually be welcomed by many IDTFs, but the scope of the requirement is quite unclear and raises the question regarding what to do with such agreements in place after February 26.
2. CMS would deny payments to enrolled IDTFs for services performed prior to enrollment date. This would have been a major departure from existing practices and a requirement not imposed on any other supplier type.
3. IDTFs would have been required to use only technologists who are full-time W-2 employees of the IDTF. At issue is why must they be employed, and why full time. CMS appears to be rethinking this restriction.
4. All enrollment requirements must have been met by a physician before an interpreting physician can be permitted to provide services for the IDTF. Thus, it appears an IDTF could not receive interpretation services from a radiologist who is going through a carrier/ contractor’s individual physician enrollment process.
5. The Medicare carrier/contractor must independently verify insurance coverage of the IDTF seeking enrollment.
6. There was 30 day reporting period requirement for changes to any of the structure or physician or non-physician (technologist) staffing. IDTFs would appear to have a tighter deadline than any other Medicare supplier type. And it undoubtedly will add to the already large burden imposed on carrier/contractor provider enrollment staffs, exacerbating the delays in the enrollment process that could make the punitive features of this transmittal even more painful to IDTFs going through the enrollment process.
7. The supervising physician would be responsible for the overall operation and administration of the IDTF, including the employment of personnel who are competent to perform test procedures, record and report test results promptly, accurately and proficiently, and for assuring compliance with the applicable regulations. This language appears to shift the overall responsibilities of the supervising physician from exclusively professional to include management services. While it is certainly true that a physician providing general supervision should be responsible for the direction of the overall quality of the technical (clinical) services in the facility, this provision seems to convert the supervising physician into an administrative manager rather than medical director.

Finally, of particular concern to radiologists was the deletion of the criteria that distinguishes a radiologist’s office from an IDTF, creating concern that Medicare carriers could try to force even radiologist-owned offices (or radiology group-hospital joint ventured imaging centers) into IDTF status.

CMS was under intense pressure to not implement these new rules and responded to the
concerns of the IDTF industry. The fact that CMS rescinded the transmittal gives hope that the any future substantive changes to the IDTF rules will come via notice and comment through formal rulemaking.

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