decisionhealth Newsletters, Part B News - 2017 Issue 12 (December)
Hundreds of lab codes expected to earn less revenue in 2018 as cuts take hold
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Article Overview
This article explains upcoming Medicare payment changes for clinical laboratory testing under the Clinical Laboratory Fee Schedule, with attention to CMS’s PAMA implementation and the categories of lab tests expected to see higher or lower rates in 2018. It is aimed at physician practices, office labs, coders, and reimbursement staff who need to understand the scope of the changes, the organizations involved, and why the shift matters for lab revenue and operations.
Why This Topic Matters
It helps readers gauge whether their frequently billed laboratory services may be affected by CMS payment updates and understand the broader operational impact on office-based testing and revenue planning.
Article Sections
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Medicare lab payment changes for 2018
Overview of the CMS rate reset and the general impact on laboratory reimbursement in the coming year. The section frames the policy change and its significance for practices that perform testing.
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Impact on commonly billed laboratory tests
Discussion of how the payment changes are expected to affect heavily reported laboratory services and practice revenue. The section summarizes the scope of the affected code population and the operational concerns raised by stakeholders.
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Some charges will increase
Summary of the subset of laboratory services expected to receive higher payments in 2018. The section notes that not all pricing changes move in the same direction.
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Projected 2018 payment rates for a sampling of lab codes
A table of selected laboratory billing codes and projected payment changes for 2018. The section provides examples of codes discussed in the article without explaining their clinical or billing details.
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30 most-reported lab codes and expected 2018 payment rates
A listing of frequently billed laboratory testing codes that are expected to be affected by the 2018 payment update. The section is intended to help readers identify high-volume services that may be relevant to their practice.
What You Will Learn
- What policy change is driving the 2018 Medicare laboratory payment update
- Which broad categories of laboratory services are affected by the rate changes
- How the article frames the operational impact on physician practices and office labs
- What kinds of supplemental CMS resources are referenced for follow-up
- How the article organizes examples of high-volume testing services and projected payment movement
Who Should Read This
- Physician practices
- Office laboratory managers
- Medical coders
- Reimbursement specialists
- Revenue cycle staff
- Primary care providers
Codes Discussed
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