National Academies Press: OpenBook

Medicare Laboratory Payment Policy: Now and in the Future (2000)

Chapter: Appendix E: 1998 Medicare Carrier Denial Rates

« Previous: Appendix D: Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000
Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

APPENDIX E
1998 Medicare Carrier Denial Rates

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

TABLE E.1 1998 Medicare Carrier Denial Rates for Top 100 CPT Codes

Obs. No.

CPT

Description

Total Claims

Allowed Services

Denied Claims

Percent Denied

1

G0001

Venipuncture

54,308,311

50,522,357

3,785,954

7

2

80061

Lipid panel

10,012,394

8,112,908

1,899,486

19

3

85025

Automated hemogram

13,484,091

10,641,281

2,842,810

21

4

84443

Assay TSH

5,871,658

4,579,775

1,291,883

22

5

80054

Comp metabolic panel

10,290,202

9,491,333

798,869

8

6

85024

Automated hemogram

8,662,269

7,358,832

1,303,437

15

7

84153

Assay of PSA, total

4,756,531

3,284,409

1,472,122

31

8

80092

Thyroid panel w/TSH

2,534,185

1,974,563

559,622

22

9

85610

Prothombin time

14,291,139

12,574,088

1,717,051

12

10

83036

Glycated hemoglobin test

5,066,357

4,162,652

903,705

18

11

80049

Metabolic panel, basic

5,828,554

5,468,084

360,470

6

12

81000

Urinalysis, nonauto w/scope

10,333,195

9,197,005

1,136,190

11

13

87086

Urine culture/colony count

3,470,828

2,977,871

492,957

14

14

83970

Assay of parathormone

607,387

563,481

43,906

7

15

88342

Immunocytochemistry

773,537

679,395

94,142

12

16

80162

Assay of digoxin

2,217,224

1,719,286

497,938

22

17

82607

Vitamin B-12

1,293,984

1,148,163

145,821

11

18

82728

Assay of ferritin

1,676,425

1,206,352

470,073

28

19

82947

Assay of glucose, quant

6,808,196

5,095,476

1,712,720

25

20

83718

Assay of lipoprotein

2,735,590

1,971,582

764,008

28

21

80058

Hepatic function panel

3,257,316

2,793,817

463,499

14

22

83550

Iron-binding test

2,222,641

1,672,426

550,215

25

23

83540

Assay of iron

3,125,180

2,065,183

1,059,997

34

24

85023

Automated hemogram

1,679,112

1,482,497

196,615

12

25

87186

Antibiotic sensitivity, mic

1,541,216

1,423,826

117,380

8

26

88312

Special stains

750,231

691,029

59,202

8

27

82746

Blood folic acid serum

912,478

791,881

120,597

13

28

80185

Assay of phenytoin, total

839,618

778,174

61,444

7

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

29

87340

Hep B surface antigen, EIA

1,066,065

990,005

76,060

7

30

82378

Carcinoembryonic antigen

717,046

523,034

194,012

27

31

88180

Cell marker study

765,834

578,032

187,802

25

32

87088

Urine bacteria culture

1,421,349

1,208,672

212,677

15

33

81001

Urinalysis, auto w/scope

3,123,900

2,832,521

291,379

9

34

82108

Assay of aluminum

374,227

347,575

26,652

7

35

83721

Assay of blood lipoprotein

1,016,926

890,414

126,512

12

36

85651

RBC sed rate, nonautomated

2,852,933

2,382,302

470,631

16

37

84439

Assay of free thyroxine

1,043,574

875,160

168,414

16

38

81002

Urinalysis nonauto w/o scope

3,672,390

3,040,808

631,582

17

39

84132

Assay of serum potassium

3,228,326

2,903,922

324,404

10

40

85027

Automated hemogram

1,347,928

1,117,113

230,815

17

41

80051

Electrolyte panel

1,686,997

1,564,619

122,378

7

42

84460

Alanine (alt) (SGPT)

4,473,439

4,022,030

451,409

10

43

82565

Assay of creatine

3,690,794

3,361,129

329,665

9

44

83735

Assay of magnesium

1,658,816

1,051,152

607,664

37

45

84436

Assay of total thyroxine

1,328,819

967,532

361,287

27

46

87070

Culture specimen, bacteria

795,903

732,725

63,178

8

47

88313

Special stains

714,671

644,559

70,112

10

48

82270

Test for blood, feces

3,582,984

2,406,732

1,176,252

33

49

84480

Assay, triiodothyronine (t3)

478,533

427,966

50,567

11

50

86038

Antinuclear, antibodies

490,385

449,731

40,654

8

51

86235

Nuclear antigen antibodies

355,112

310,794

44,318

12

52

80059

Hepatitis panel

111,194

89,049

22,145

20

53

84165

Assay of serum proteins

478,051

441,159

36,892

8

54

82962

Glucose blood test

2,025,904

1,624,456

401,448

20

55

83615

Lactate (LD) (LDH) enzyme

3,590,958

3,229,463

361,495

10

56

82465

Assay of serum cholesterol

3,796,842

2,545,361

1,251,481

33

57

84550

Assay of blood uric acid

3,631,496

3,269,558

361,938

10

58

80164

Assay, dipropylaoctic acid

384,222

358,712

25,510

7

59

86316

Immunoassay, tumor antigen

380,049

230,267

149,782

39

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

Obs. No.

CPT

Description

Total Claims

Allowed Services

Denied Claims

Percent Denied

60

84520

Assay of urea nitrogen

3,142,103

2,829,708

312,395

10

61

84134

Assay of prealbumin

369,369

337,573

31,796

9

62

80091

Thyroid panel

494,986

341,512

153,474

31

63

87184

Antibiotic sensitivity, each

710,761

662,935

47,826

7

64

84466

Assay of transferrin

412,205

368,777

43,428

11

65

85021

Automated hemogram

945,869

785,785

160,084

17

66

88311

Decalcify tissues

521,382

476,714

44,668

9

67

84450

Transfarase (AST) (SGOT)

2,472,065

2,207,233

264,832

11

68

84403

Assay of total testosterone

182,640

166,282

16,358

9

69

80198

Assay of theophylline

316,372

296,049

20,323

6

70

85730

Thromboplastin time, partial

1,011,362

672,243

339,119

34

71

84100

Assay of phosphrus

3,277,539

2,945,742

331,797

10

72

88358

Analysis, tumor

45,022

33,684

11,338

25

73

82784

Assay of gammaglobulin IGM

475,411

443,826

31,585

7

74

80156

Assay of carbamazepine

290,031

270,482

19,549

7

75

87536

HIV-1 DNA, guant

61,753

50,847

10,906

18

76

88156

Cytopath cerv/vag tbs

1,123,563

705,034

418,529

37

77

p3000

Screen Pap by tech w md spuv

 

696,620

 

 

78

86677

Helicobacter pylori

294,970

261,064

33,906

11

79

87163

Special microbiology culture

365,712

332,893

32,819

9

80

85022

Automated hemogram

721,987

625,796

96,191

13

81

86706

Hepatitis B surface antibody

318,970

291,801

27,169

9

82

82977

Assay of GGT

2,710,498

1,776,256

934,242

34

83

82985

Glycated protein

267,351

207,433

59,918

22

84

82310

Assay of calcium

1,835,714

1,627,676

208,038

11

85

84478

Assay of triglycerides

2,325,893

1,547,433

778,460

33

86

82150

Assay of amylase

522,595

457,640

64,955

12

87

81003

Urinalysis, auto w/o scope

1,524,186

1,304,784

219,402

14

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

88

80100

Drug screen

236,133

206,622

29,511

12

89

86803

Hepatitis c ab test

221,837

198,565

23,272

10

90

80101

Drug screen

281,363

242,105

39,258

14

91

82131

Amino acids, single quant

200,511

166,743

33,768

17

92

85045

Reticulocyte count

718,565

643,016

75,549

11

93

82550

Assay of CK (CPK)

992,983

888,071

104,912

11

94

88346

Immunofluorescent study

100,003

87,556

12,447

12

95

86003

Allergen specific ige

642,755

537,312

105,443

16

96

G0107

CA screen fecal blood test

 

909,427

 

 

97

84295

Assay of serum sodium

1,605,560

1,449,005

156,555

10

98

86334

Immunofixation procedure

112,513

103,770

8,743

8

99

85007

Differential WBC Count

677,050

590,005

87,045

13

100

80158

Assay of cyclosporine

122,397

109,266

13,131

11

 

 

AVERAGE

266,287,495

228,699,563

39,193,969

15

NOTE: The committee was unable to obtain an explanation for the denials. Since many of the tests with high denial rates are not screening tests, this does not fully explain the high denial rates. Other possible reasons for claims denials include stringent local medical review policies, contractors’ inability to match ICD-9 codes with the appropriate CPT codes due to flaws in their computer programs, duplicative bills for a claim that was already paid, the patient is not eligible for benefits, the provider is not an approved Medicare provider, or the provider is billing for a type of test that is outside the laboratory’s CLIA certification level. There appears to be no obvious pattern to the denial rates. One test that has a high rate of denial in one carrier region will have a very low denial rate in another carrier region.

AST = aspartate transominase; CK = creatine kinase; CPK = creatine phosphokinase; CPT = Current Procedural Terminology; EIA = enzyme immunoassay; GGT = γ-glutamyl transferase; MIC = minimum inhibitory concentration; PSA = prostate-specific antigen; RBC = red-blood cell; SGOT = serum glutamic-oxalvacetic transaminase; SGPT = serum glutamic-pyruvic transaminase; TSH = thyroid-stimulating hormone; WBC = white-blood cell.

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

TABLE E.2 1998 Medicare Carrier Denial Rates for the Top 20 Clinical Laboratory Tests, by State

 

 

Denial Rate (percentage)

 

 

510

511

520

521

522

528

590

621

623

CPT Code

Description

AL

GA

AR

NM

OK

LA

FL

IL

MI

G0001

Venipuncture

5

7

5

8

6

7

7

7

5

80061

Lipid panel

14

17

5

25

14

16

15

23

17

85025

Automated hemogram

27

35

5

29

5

17

14

34

35

84443

Assay TSH

19

26

23

30

17

30

26

8

7

80054

Comp metabol panel

6

8

5

6

4

6

6

9

6

85024

Automated hemogram

18

16

4

6

8

13

12

19

19

84153

Assay of PSA, totala

41

33

53

32

11

50

41

29

30

80092

Thyroid panel w/TSHb

25

8

30

20

14

27

21

22

8

85610

Prothrombin time

9

12

4

14

12

12

13

15

15

83036

Glycated hemoglobin test

14

20

13

20

14

19

17

17

18

80049

Metabolic panel, basic

4

6

4

5

3

4

5

7

4

81000

Urinalysis, nonauto w/scope

20

16

13

7

12

5

8

9

6

87086

Urine culture/colony count

12

18

6

7

3

18

15

23

19

83970

Assay of parathormone

4

28

3

8

4

9

5

5

6

88342

Immunocytochemistry

21

6

12

33

25

12

10

31

21

80162

Assay of digoxin

30

49

26

17

12

22

24

47

53

82607

Vitamin B-12

5

6

6

6

3

8

6

9

6

82728

Assay of ferritin

32

33

53

38

17

55

9

15

17

82947

Assay of glucose, quant

25

27

21

14

8

19

29

26

39

83718

Assay of lipoprotein

19

27

7

45

29

37

34

40

41

80058

Hepatic function panel

48

46

6

5

4

47

5

7

4

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

 

 

Denial Rate (percentage)

 

 

630

640

650

655

660

740

751

801

803

CPT Code

Description

IN

IA

KS

NE

KY

MO

MT

NY(W)

NY(E)

G0001

Venipuncture

7

4

2

3

5

4

32

7

12

80061

Lipid panel

15

9

23

25

15

34

19

7

20

85025

Automated hemogram

7

5

5

9

31

5

65

12

33

84443

Assay TSH

38

16

9

11

21

15

39

24

33

80054

Comp metabol panel

7

10

3

6

10

5

16

6

11

85024

Automated hemogram

9

7

3

6

14

4

29

6

27

84153

Assay of PSA, totala

54

46

30

30

26

36

41

46

46

80092

Thyroid panel w/TSHb

39

15

12

10

23

15

34

20

26

85610

Prothrombin time

16

2

7

6

43

9

34

12

21

83036

Glycated hemoglobin test

17

3

8

9

5

12

41

19

39

80049

Metabolic panel, basic

6

5

3

3

7

3

24

4

10

81000

Urinalysis, nonauto w/scope

6

13

4

5

12

7

38

14

22

87086

Urine culture/colony count

5

7

6

14

7

11

44

21

24

83970

Assay of parathormone

8

10

6

75

7

6

13

12

58

88342

Immunocytochemistry

7

11

5

8

23

7

1

7

10

80162

Assay of digoxin

17

2

12

12

7

13

33

21

30

82607

Vitamin B-12

10

42

3

5

8

4

43

18

20

82728

Assay of ferritin

49

19

24

23

33

26

62

42

46

82947

Assay of glucose, quant

12

9

17

16

27

20

22

43

41

83718

Assay of lipoprotein

17

14

46

40

17

34

68

34

28

80058

Hepatic function panel

6

4

3

4

15

4

15

4

9

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

 

 

Denial Rate (percentage)

 

 

820

824

825

831

832

833

834

835

836

860

CPT Code

Description

N/SD

CO

WY

AK

AZ

HI

NV

OR

WA

NJ

G0001

Venipuncture

4

10

7

4

12

4

10

5

6

4

80061

Lipid panel

8

23

15

16

33

7

26

14

6

29

85025

Automated hemogram

5

17

7

10

21

14

12

8

6

5

84443

Assay TSH

17

32

23

24

41

19

36

25

27

16

80054

Comp metabol panel

5

15

7

5

17

11

9

5

5

4

85024

Automated hemogram

7

8

9

15

6

10

6

12

7

6

84153

Assay of PSA, totala

53

54

46

36

33

20

35

26

27

21

80092

Thyroid panel w/TSHb

15

29

17

24

31

19

27

16

20

13

85610

Prothrombin time

5

14

9

10

24

13

24

10

14

10

83036

Glycated hemoglobin test

6

22

12

26

31

17

29

18

5

29

80049

Metabolic panel, basic

4

11

4

6

13

11

12

4

5

3

81000

Urinalysis, nonauto w/scope

12

25

15

7

9

10

21

8

7

10

87086

Urine culture/colony count

10

19

12

7

11

4

7

5

5

15

83970

Assay of parathormone

6

12

5

0

21

14

12

4

9

5

88342

Immunocytochemistry

5

12

11

40

14

5

3

4

9

8

80162

Assay of digoxin

1

13

7

4

15

4

8

4

5

20

82607

Vitamin B-12

50

57

49

3

20

4

11

6

6

5

82728

Assay of ferritin

24

46

39

28

47

17

38

24

32

46

82947

Assay of glucose, quant

10

24

12

22

48

26

44

28

10

25

83718

Assay of lipoprotein

12

42

23

33

36

18

36

23

7

19

80058

Hepatic function panel

5

10

6

19

66

9

75

24

5

4

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

 

 

Denial Rate (percentage)

 

 

865

870

880

900

901

902

903

910

951

973

CPT Code

Description

PA

RI

SC

TX

MD

DE

DC

UT

WI

PR/VI

G0001

Venipuncture

4

15

6

5

6

18

5

7

4

6

80061

Lipid panel

20

16

34

13

13

19

27

25

13

7

85025

Automated hemogram

5

34

19

33

33

39

37

36

25

6

84443

Assay TSH

12

27

31

24

25

35

27

48

18

9

80054

Comp metabol panel

4

10

9

6

7

16

5

12

7

7

85024

Automated hemogram

5

8

25

18

21

5

14

24

21

5

84153

Assay of PSA,totala

18

35

61

21

27

36

31

27

24

23

80092

Thyroid panel w/TSHb

10

22

72

22

20

35

27

49

54

10

85610

Prothrombin time

6

20

17

15

15

16

18

15

12

6

83036

Glycated hemoglobin test

20

32

16

19

21

25

21

20

11

6

80049

Metabolic panel, basic

4

9

7

4

6

14

4

8

4

5

81000

Urinalysis, nonauto w/scope

6

8

9

7

10

18

9

7

4

6

87086

Urine culture/colony count

9

8

15

15

17

19

24

14

20

6

83970

Assay of parathormone

25

11

13

5

7

4

5

13

5

7

88342

Immunocytochemistry

5

28

12

4

3

1

5

5

4

12

80162

Assay of digoxin

15

9

34

23

24

38

31

17

19

4

82607

Vitamin B-12

4

12

9

9

8

38

5

20

39

5

82728

Assay of ferritin

26

45

30

30

33

47

34

59

21

6

82947

Assay of glucose, quant

15

19

30

22

33

41

39

34

9

23

83718

Assay of lipoprotein

21

28

46

24

19

42

30

36

19

15

80058

Hepatic function panel

3

8

8

5

7

9

4

9

4

7

G0001

Venipuncture

10

8

8

7

15

11

6

11

7

6

80061

Lipid panel

26

18

18

19

14

9

24

41

14

21

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

 

 

Denial Rate (percentage)

 

 

2050

5130

5440

5535

10071

10230

10240

10250

10490

11260

CPT Code

Description

CA(T)

ID

TN

NC

RR

CT

MN

MS

VA

MO

85025

Automated hemogram

29

6

61

35

15

9

13

26

6

33

84443

Assay TSH

15

28

34

24

15

13

13

23

14

23

80054

Comp metabol panel

9

7

11

16

15

8

4

8

4

10

85024

Automated hemogram

19

8

32

31

16

9

40

26

7

22

84153

Assay of PSA, totala

25

40

32

44

15

7

52

34

18

46

80092

Thyroid panel w/TSHa

20

30

33

27

15

10

11

 

9

25

85610

Prothrombin time

7

14

14

12

15

7

7

17

8

13

83036

Glycated hemoglobin test

19

23

19

15

15

10

11

7

14

23

80049

Metabolic panel, basic

9

8

8

10

15

12

4

6

3

9

81000

Urinalysis, nonauto w/scope

15

7

11

17

16

13

18

21

13

7

87086

Urine culture/colony count

14

23

20

16

15

7

11

4

8

19

83970

Assay of parathormone

8

3

8

9

12

13

5

12

8

5

88342

Immunocytochemistry

14

8

12

11

24

14

16

12

11

27

80162

Assay of digoxin

9

13

20

27

15

8

12

16

7

16

82607

Vitamin B-12

11

5

11

38

16

11

3

12

7

5

82728

Assay of ferritin

31

42

16

38

13

44

10

20

8

30

82947

Assay of glucose, quant

20

38

29

30

19

13

4

24

18

41

83718

Assay of lipoprotein

16

30

28

20

19

14

21

22

9

25

80058

Hepatic function panel

11

5

9

9

14

10

4

6

4

53

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

 

 

Denial Rate (percentage)

 

 

14330

16360

16510

31140

31142

31143

31144

31145

CPT Code

Description

NY(G)

OH

WV

CA(N)

ME

MA

NH

VT

G0001

Venipuncture

8

6

5

9

4

5

6

5

80061

Lipid panel

15

18

12

37

9

9

12

15

85025

Automated hemogram

24

7

6

12

9

7

11

10

84443

Assay TSH

16

24

16

47

16

15

19

22

80054

Comp metabol panel

7

7

5

14

6

5

10

4

85024

Automated hemogram

20

4

3

6

7

10

10

7

84153

Assay of PSA, totala

29

24

19

38

27

28

32

38

80092

Thyroid panel w/TSHb

16

40

37

44

14

10

16

11

85610

Prothrombin time

14

13

12

6

10

7

10

9

83036

Glycated hemoglobin test

14

15

10

10

14

11

16

22

80049

Metabolic panel, basic

4

5

4

8

3

4

5

5

81000

Urinalysis, nonauto w/scope

24

7

3

11

5

9

6

7

87086

Urine culture/colony count

16

14

8

6

17

11

18

16

83970

Assay of parathormone

8

15

4

3

10

5

7

NA

88342

Immunocytochemistry

12

4

3

10

5

11

4

2

80162

Assay of digoxin

17

24

22

7

21

15

19

25

82607

Vitamin B-12

13

7

6

1

8

6

10

4

82728

Assay of ferritin

41

33

27

5

29

19

22

30

82947

Assay of glucose, quant

44

22

15

15

19

25

28

19

83718

Assay of lipoprotein

14

27

20

56

16

21

21

19

80058

Hepatic function panel

6

5

4

69

5

4

7

5

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×

NOTE: The committee was unable to obtain an explanation for the denials. Since many of the tests with high denial rates are not screening tests, this does not fully explain the high denial rates. Other possible reasons for claims denials include stringent local medical review policies, contractors’ inability to match ICD-9 codes with the appropriate CPT codes due to flaws in their computer programs, duplicative bills for a claim that was already paid, the patient is not eligible for benefits, the provider is not an approved Medicare provider, or the provider is billing for a type of test that is outside the laboratory’s CLIA certification level. There appears to be no obvious pattern to the denial rates. One test that has a high rate of denial in one carrier region will have a very low denial rate in another carrier region.

LMRP = local medical review policy; PSA = prostate specific antigen; TSH = thyroid-stimulating hormone.

aCoverage was recently extended to screening, once per year.

bPanel was eliminated in 2000 but there will still be LMRP for each individual test.

Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
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Suggested Citation:"Appendix E: 1998 Medicare Carrier Denial Rates." Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. Washington, DC: The National Academies Press. doi: 10.17226/9997.
×
Page 236
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Medicare Laboratory Payment Policy: Now and in the Future Get This Book
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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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