Medicare Laboratory Payment Policy:

Now and in the Future

Status: Available Now

Size: 264 pages, 6 x 9

Publication Year:2000

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PAPERBACK ISBN-10: 0-309-07266-2 ISBN-13: 978-0-309-07266-3	$34.00	$30.60	Add to Cart

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Authors:
Dianne Miller Wolman, Andrea L. Kalfoglou, and Lauren LeRoy, Editors, Committee on Medicare Payment Methodology for Clinical Laboratory Services, Division of Health Care Services
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Description:
Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. ...
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Table of Contents
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Front Matter	i-xx
Summary	1-17	(skim)
1 Introduction	18-28	(skim)
2 Background and Environmental Trends	29-57	(skim)
3 Technology Trends in the Clinical Laboratory Industry	58-74	(skim)
4 Description of the Current Medicare Payment System and Its Historical Roots	75-99	(skim)
5 The Current System: How Well Does It Work?	100-115	(skim)
6 Alternative Payment Methodologies	116-143	(skim)
7 Recommendations	144-162	(skim)
Acronyms and Glossary	163-172	(skim)
Appendix A: Acknowledgments	173-176	(skim)
Appendix B: Medicare Clinical Laboratory Payments: The National Limitation Amount and Its Relationship to Payment Amounts	177-183	(skim)
Appendix C: Study of Fees and Payment System Characteristics for Clinical Laboratory Services	184-214	(skim)
Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000	215-224	(skim)
Appendix E: 1998 Medicare Carrier Denial Rates	225-236	(skim)
Appendix F: Committee Biographies	237-242	(skim)

Description

Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system.

Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

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Institute of Medicine (IOM)

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