Medicare-Approved Independent Diagnostic Testing Facility (IDTF)
What is an IDTF?
Medicare inpatient and outpatient clinical and diagnostic services can be provided in many different settings, such as a physician’s office, hospital, or an Independent Diagnostic Testing Facility (IDTF). An IDTF is a type of Medicare provider that is independent of a physician’s office or hospital. However, IDTF general coverage and payment policy rules do apply when an IDTF furnishes diagnostic procedures in a physician’s office. Effective for diagnostic procedures performed on or after March 15, 1999, Medicare Administrative Contractors (MACs) pay for diagnostic procedures under the physician fee schedule when performed by an IDTF.
An IDTF can be a fixed location or a mobile entity, and can be considered independent from a physician’s office or hospital if;
- The physician practice is not owned directly by one or more physicians or by a hospital.
- The entity bills primarily for diagnostic tests, and not for patient services.
- The diagnostic tests are not performed and interpreted at the same location where the practice physicians also treat their patients.
In order for an IDTF to be authorized to provide services and submit claims on behalf of Medicare beneficiaries, it must be Medicare-approved. Any IDTF that wishes to become Medicare-approved must first submit an application that collects information including procedure codes for billing, names of supervising physicians and technicians, locations where medical documents will be held, and the address at which they will provide services. An IDTF must separately enroll each of its practice locations (with the exception of locations that are used solely as warehouses or repair facilities). Each separately enrolled practice location of the IDTF must meet all applicable IDTF requirements.
Failure to comply with any of the requirements for a Medicare-approved IDTF will result in the revocation of its Medicare billing privileges. IDTFs must operate in compliance with all applicable federal and state licensure and regulatory requirements for the health and safety of patients.
Vitalistics™ is a Medicare-Approved IDTF specializing in home sleep testing and overnight pulse oximetry testing. Our services are designed to comply with all IDTF Performance Standards and CMS guidelines for oxygen and PAP qualification.
Why an IDTF is Required for Oxygen Qualification
Durable Medical Equipment providers (DME) provide oxygen to patients who qualify. However, an IDTF is needed in order to qualify government beneficiary patients. The Office of Inspector General (OIG) implemented a policy in 1995 for all DME providers to use only Independent Diagnostic Testing Facilities to qualify all government beneficiaries for home oxygen. In 2016, OIG implemented another policy that required IDTFs to process Home Sleep Testing and mandated that DME providers are no longer allowed to perform the Home Sleep Test and supply therapy to Medicare beneficiaries.
Ordering and Billing Requirements
All procedures performed by the IDTF must be specifically ordered in writing by the physician or practitioner who is treating the patient for a specific medical problem, and who uses the results in the management of the patient’s well-being. The order must specify the diagnosis or other explanation for the testing. The supervising physician for the IDTF may not order tests to be performed by the IDTF, unless the IDTF’s supervising physician is, in fact, the beneficiary’s treating physician. Meaning, the physician in question had a relationship with the beneficiary prior to the performance of the testing and is treating the beneficiary for a specific medical problem. The IDTF may not add any procedures based on internal protocols without a written order from the treating physician.
Vitalistics makes this process easy and efficient for all DMEs and Physicians. We handle all Medicare billing and provide patients and physicians with rapid reliable results. More information on the testing process and benefits of having Vitalistics as your Medicare-Approved IDTF is available on our DME and physician pages.