decisionhealth Newsletters, Part B News - 2019 Issue 7 (July)
Practices reap millions on most-billed diagnostic panels; watch the outliers
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Article Overview
This article is aimed at practices, independent laboratories, and billing teams that report diagnostic laboratory services. It summarizes Medicare claims data from 2016 and 2017 for the most commonly billed diagnostic panels, compares volume with total payment, and points out a few services with notably higher denial rates. The piece is relevant for understanding utilization patterns, reimbursement concentration, and where audit scrutiny may be increasing.
Why This Topic Matters
High-volume diagnostic testing can account for substantial revenue, but denial-rate outliers and shifting audit focus can affect payment integrity and compliance efforts. The article helps revenue cycle and coding professionals recognize which lab services are common, which generate the most payments, and where claims performance may warrant closer review.
What You Will Learn
- Which diagnostic lab panels were reported most frequently in Medicare claims data
- How total reimbursement can differ from claim volume across common laboratory services
- Which lab services stood out for higher denial rates
- Why diagnostic service claims may attract increased audit attention
Who Should Read This
- Medical billers
- Coding professionals
- Independent laboratories
- Physician practices
- Revenue cycle staff
- Compliance/audit teams
Codes Discussed
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