The Final Rule addresses other disclosure issues in the Comments and Response section:

  • The disclosure requirement applies only to the advanced imaging services specified in Section 6003 of the PPACA, which are MRI, CT, and PET services. CMS declined to expand the disclosure requirements to any of the other radiology or imaging services, including X-rays and ultrasound services.
  • The disclosure requirement does not apply to any request that is not a “referral” as defined in § 411.351. Requests by a radiation oncologist for radiation therapy or ancillary services necessary for, and integral to, the provision of radiation therapy does not constitute a “referral,” as defined in § 411.351. Therefore, the use of a CT scanner for the performance of radiation therapy treatments does not require a disclosure notice.
  • The disclosure notice must be presented to the patient each time one of the listed advanced imaging services is referred. Patients should receive the disclosure each time these services are needed, not just for the initial service. The patient should be made aware that he or she may obtain the services from another supplier any time advanced imaging is ordered.
  • For subsequent referrals made via a phone call, the written disclosure must still be provided to the patient and adequately documented. Mailing or e-mailing the disclosure to the patient would be acceptable if verbal notification also has occurred.
  • CMS does not plan on posting standard disclosure language for the notice. Instead, each physician office will be responsible for drafting the notice.
  • Nothing in Section 6003 of the PPACA prohibits a physician from including language informing the patients that inclusion of other suppliers is not intended as an endorsement or recommendation of those suppliers.
  • The referring physician is not required to include hospitals in the written list of alternative suppliers which provide imaging services since hospitals are “providers of services” not “suppliers.” However, physicians are not precluded from listing hospitals in the disclosure notice as long as the required number of suppliers also is included. CMS encourages physicians to list a hospital on the disclosure notice as an alternative location where no other suppliers exist in the 25-mile radius.
  • CMS will not grant an exception to providing the disclosure notice to patients at the time of referral in cases of an emergency or time-sensitive nature. In those situations, physicians should make reasonable attempts to provide the notice to the patient and document that the attempt was made.
  • In compiling the list of alternative suppliers the physician may use any reasonable means that he or she chooses in order to list the five alternative suppliers. CMS notes that some physicians may choose to compile the list of suppliers from an Internet search; others may know suppliers in the 25-mile radius who provide quality imaging and list these.
  • Credentialed facilities are not given special designation on the disclosure notice. However, nothing in the statute or the Final Rule prevents a referring physician from furnishing a list that designates a supplier’s credentialing status.
  • The referring physician should list suppliers that are able to perform the services for which the patient is being referred. Listing suppliers that are unable to perform the needed test does not provide the patient with meaningful choices about his or her care, as required by the statute and Final Rule.
  • CMS suggests that the list of suppliers should be reviewed annually for accuracy and updated at that time, if necessary.
  • Physicians are not obligated to list only suppliers that are accepting new Medicare patients; however, as the disclosure notice is intended to allow patients to make informed choices, referring physicians should make a reasonable effort to ensure that the suppliers listed in the disclosure are viable options for all of their patients for the services being referred.
  • Physicians are not required to obtain the patient’s signature or maintain a copy of such in the medical record. However, CMS notes, as a matter of prudent business practices, physicians should be able to document or otherwise establish that they have complied with the disclosure requirement.