Publications: Amendment to Illinois Rule Allows IDTFs to Bill Medicaid for the Technical Component of Testing Services

On July 25, 2011, a new rulemaking amended the Illinois Administrative Code to add independent diagnostic testing facilities (IDTFs) as eligible providers of service. Prior to this rulemaking, Illinois Medical Assistance Programs (e.g., Medicaid) only reimbursed IDTFs partially and indirectly– by reimbursing for the professional component of a test (interpretation and analysis) under the referring physician’s provider number. Now IDTFs can receive direct reimbursement under Medicaid, and the medical programs associated with it, for both the technical and professional components of the services they render.

In order to take advantage of these new Medicaid provisions, IDTFs must be approved and certified for participation in the federal Medicare program.

Reimbursable IDTF services include, but are not limited to: abdominal, pelvic and small parts ultrasound; echocardiography; arterial, venous and carotid examination with Doppler and color flow analysis; cardiac monitoring; cardiac diagnostic testing; mammography; radiological imaging; mobile imaging services and sleep studies. In order to receive reimbursement, the diagnostic and imaging tests must be certified by Medicare.

This rulemaking signals the Illinois Department of Healthcare and Family Services’ acknowledgment of the market trend of providing testing services at facilities with lower overhead costs, like hospital-based clinics and other off-site providers, as opposed to exclusively at inpatient hospitals. Outpatient facilities continue to play a vital role in the provision of affordable healthcare services to the State’s more vulnerable populations, as evidenced by Cook County, Illinois’ decision to move to an outpatient facility-centric model of healthcare delivery.

The full text of the amended rule (89 Ill. Admin. Code 140.438) can be found here.

Should you have any questions regarding the laws or regulations associated with the establishment or operation of an IDTF, please contact a member of the Ungaretti & Harris Healthcare Group.