What established the Anti-Markup Rule in the Medicare Physician Fee Schedule?

The Anti-Markup Rule in the Medicare Physician Fee Schedule was established as part of legislation passed in 2009. This rule was implemented to address concerns about the practice of "marking up" the fees for diagnostic tests and services provided to Medicare beneficiaries when those services are not performed in the same location where the physician or supplier billed for them.

The 2009 legislation targeted specific practices to ensure that payments reflected the actual costs of the services provided, thereby safeguarding against potential abuses and overcharges in the healthcare system. By requiring that payment be made only for the services that were directly rendered, the Anti-Markup Rule aimed to enhance the integrity of the billing process under Medicare.

Understanding the foundation of this rule helps clarify its purpose in promoting transparency and equitable billing practices in healthcare delivery, demonstrating the ongoing efforts to regulate and refine the Medicare payment landscape.