decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
ESRD / Fraud alerts / ESRD arrangements for laboratory tests
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Article Overview
This article covers Medicare reimbursement arrangements for laboratory tests furnished to ESRD patients, with emphasis on how lab payment responsibilities are handled when services are included in a composite rate. It is relevant to dialysis providers, laboratories, and billing/compliance staff who need to understand the general Medicare payment structure and avoid improper billing practices.
Why This Topic Matters
ESRD laboratory testing is subject to Medicare payment rules that affect how facilities and external laboratories coordinate billing and reimbursement. Understanding these arrangements helps organizations reduce billing risk and support compliant claim submission and payment practices.
What You Will Learn
- How Medicare payment arrangements for ESRD-related laboratory testing are structured at a high level.
- Why agreements between ESRD facilities and outside testing entities can create compliance concerns.
- The general fraud-alert context surrounding billing for services included in ESRD payment arrangements.
Who Should Read This
- ESRD facilities
- Dialysis providers
- Clinical laboratories
- Medical coders
- Billing staff
- Compliance staff
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