decisionhealth Newsletters, Part B News - 2019 Issue 1 (January)
GAO: New payment rates for Part B lab tests may lead to billions in overpayments
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Article Overview
This article reviews a Government Accountability Office report on Medicare Part B laboratory test reimbursement. It explains the background for CMS’s updated payment methodology under PAMA, the use of private payer data, the phase-in of rate reductions, and the potential budget impact of changes affecting bundled versus unbundled payment for certain laboratory panels. The content is relevant to coders, billing staff, compliance teams, and reimbursement professionals who follow Medicare laboratory payment policy and related CMS implementation issues.
Why This Topic Matters
Changes in Medicare laboratory payment methodology can affect reimbursement levels, payment administration, and future policy decisions. Understanding the GAO’s findings helps stakeholders track how CMS payment-rate calculations and bundling practices may influence Part B lab spending.
Article Sections
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Physician payments
Background on Medicare Part B laboratory payment policy and the federal reporting framework used to establish revised payment rates.
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GAO findings on payment-rate impacts
Discussion of the GAO’s review of claims data, private payer data, and factors affecting the accuracy of the new reimbursement methodology.
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Bundling and panel test payment issues
Overview of CMS’s handling of panel test payment structure and the broader spending implications of bundled versus unbundled laboratory payments.
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GAO recommendations to CMS
Summary of the report’s suggested next steps for data collection, rate phase-in methodology, and authority related to laboratory test bundling.
What You Will Learn
- How Medicare Part B laboratory payment rates were updated under PAMA
- Why CMS’s use of private payer data matters for laboratory reimbursement
- What the GAO found about the potential spending impact of the new payment methodology
- How bundling practices for laboratory panels factor into Medicare payment policy
- What broad recommendations the GAO made to CMS
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Compliance professionals
- Revenue cycle teams
- Healthcare administrators
- Policy analysts
Codes Discussed
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