Rules for IDTFs / Medicare

Rules for IDTFs/Medicare

The Centers for Medicare & Medicaid Services, or CMS, falls under the Department of Health and Human Services. They administer a number of programs related to human health, the major ones which include Medicare and Medicaid. The Children’s Health Insurance Program (CHIP) and the Health Insurance Marketplace are also 2 of their most successful ventures.

The guidelines and rules for Independent Diagnostic Testing Facilities under Medicare function independently rather than being a part of a hospital or of any attending or consulting physician. This is with the exception of payment procedures which require diagnostic procedures to be performed in a physician’s office.

For an Independent Diagnostic Testing Facility, it should be open and functioning at the time it opts to be enrolled in Medicare and submits the required application, CMS-855B. If there are more than one practice locations, each would need to be enrolled separately, that is unless the locations are used for repairing or warehousing purposes. For each location, a separate CMS-855B Form would need to be submitted which would be followed by individual site visits for each applied location. Upon visits and inspection, the IDTF location enrolled under Form CMS-855B must be up to the required standards in order to be eligible for privileges and coverage. If the IDTF is found to not meet the set requirements, it’s billing privileges and coverage will be revoked.

Additionally, fixed site and mobile units must also be registered separately. In case a mobile unit is located on a fixed site, both would need to be registered under separate CMS-855B applications.

Requirements for Overnight Oximetry IDTF
In case someone wants to establish an overnight oximetry IDTF, it must comply with a set of requirements. These include, but are not limited to:

  • The business operations and attending to patients’ healthcare needs must be done as per the Federal and State licensure and regulatory requirements. 
  • The physical facility should be on a formal and proper site which cannot include a motel, post office box, hotel, etc. it should have a proper address, with a suite identifier that must be recognized and approved by the United States Postal Service (USPS). 
  • The enrolled overnight oximetry IDTF should also have a primary phone number. 
  • Should be in acceptance of no direct solicitation of the patients by any means, including over phone, computer, or even in person. 
  • The equipment at the IDTF should be maintained and calibrated according to the instructions and guidelines given by the manufacturers of the testing equipment and the standards set by them. 
  • The medical records of the facility should be properly stored and retrievable in case they are requested by CMS or MAC within a time of 2 business day. 
  • The staff with proper credentials should be appointed in order to perform the various tests required at the facility.