What is the main purpose of the Anti-Markup Rule?

The Anti-Markup Rule is designed to address specific concerns regarding billing practices in healthcare, particularly in the context of laboratory services. Its primary purpose is to prevent situations where a provider could mark up the cost of a laboratory service when they're not directly providing that service or when they are using a non-participating provider to perform the test. This means that if a healthcare entity does not conduct the lab work themselves and instead refers patients to another provider, they are restricted from charging a higher price that exceeds the actual costs incurred.

By enforcing this rule, the regulation ensures that healthcare providers are not profiting excessively from the use of services that they do not perform themselves, thereby minimizing financial discrepancies and promoting fairness in billing practices. This approach ultimately protects patients from inflated charges and maintains a level of transparency in healthcare costs. Thus, the Anti-Markup Rule serves as a critical mechanism to avoid payment for overhead to non-participating providers and to promote a more equitable billing environment.