Form Cms-855b - Medicare Enrollment Application - Clinics/group Practices And Certain Other Suppliers Page 40

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attaChMent 2: indePendent diagnoStiC teSting f aCilitieS
indePendent diagnoStiC teSting faCility (idtf) PerforManCe StandardS
Below is a list of the performance standards that an IDTF must meet in order to obtain or maintain their
Medicare billing privileges. These standards, in their entirety, can be found in 42 C.F.R section 410.33(g).
1. Operate its business in compliance with all applicable Federal and State licensure and regulatory
requirements for the health and safety of patients.
2. Provides complete and accurate information on its enrollment application. Changes in ownership,
changes of location, changes in general supervision, and adverse legal actions must be reported to
the Medicare fee-for-service contractor on the Medicare enrollment application within 30 calendar
days of the change. All other changes to the enrollment application must be reported within
90 calendar days.
3. Maintain a physical facility on an appropriate site. For the purposes of this standard, a post office
box, commercial mail box, hotel or motel is not considered an appropriate site.
(i) The physical facility, including mobile units, must contain space for equipment appropriate
to the services designated on the enrollment application, facilities for hand washing, adequate
patient privacy accommodations, and the storage of both business records and current medical
records within the office setting of the IDTF, or IDTF home office, not within the actual
mobile unit.
(ii) IDTF suppliers that provide services remotely and do not see beneficiaries at their
practice location are exempt from providing hand washing and adequate patient privacy
accommodations.
4. Have all applicable diagnostic testing equipment available at the physical site excluding portable
diagnostic testing equipment. A catalog of portable diagnostic equipment, including diagnostic
testing equipment serial numbers, must be maintained at the physical site. In addition, portable
diagnostic testing equipment must be available for inspection within two business days of a CMS
inspection request. The IDTF must maintain a current inventory of the diagnostic testing equipment,
including serial and registration numbers, provide this information to the designated fee-for-service
contractor upon request, and notify the contractor of any changes in equipment within 90 days.
5. Maintain a primary business phone under the name of the designated business. The primary business
phone must be located at the designated site of the business, or within the home office of the mobile
IDTF units. The telephone number or toll free numbers must be available in a local directory and
through directory assistance.
6. Have a comprehensive liability insurance policy of at least $300,000 per location that covers both
the place of business and all customers and employees of the IDTF. The policy must be carried
by a non-relative owned company. Failure to maintain required insurance at all times will result
in revocation of the IDTF’s billing privileges retroactive to the date the insurance lapsed. IDTF
suppliers are responsible for providing the contact information for the issuing insurance agent and
the underwriter. In addition, the IDTF must:
(i) Ensure that the insurance policy must remain in force at all times and provide coverage of at
least $300,000 per incident; and
(ii) Notify the CMS designated contractor in writing of any policy changes or cancellations.
7. Agree not to directly solicit patients, which include, but is not limited to, a prohibition on telephone,
computer, or in-person contacts. The IDTF must accept only those patients referred for diagnostic
testing by an attending physician, who is furnishing a consultation or treating a beneficiary for a
specific medical problem and who uses the results in the management of the beneficiary’s specific
medical problem. Nonphysician practitioners may order tests as set forth in §410.32(a)(3).
CMS-855B (07/11)
39

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