Medicare laboratory payment policy : now and in the future

Medicare laboratory payment policy now and in the future

Detalles Bibliográficos
Autor Corporativo: Institute of Medicine (U.S.). Committee on Medicare Payment Methodology for Clinical Laboratory Services (-)
Otros Autores: Wolman, Dianne Miller (-), Kalfoglou, Andrea L., LeRoy, Lauren
Formato: Libro electrónico
Idioma:Inglés
Publicado: Washington, D.C. ; [Great Britain] : National Academy Press c2000.
Edición:1st ed
Materias:
Hospitals > Outpatient services > Prospective payment > United States.
Medicare.
Diagnosis, Laboratory > United States.
Ver en Biblioteca Universitat Ramon Llull:https://discovery.url.edu/permalink/34CSUC_URL/1im36ta/alma991009820326106719
Tabla de Contenidos:
  • Medicare Laboratory Payment Policy
  • Copyright
  • REVIEWERS
  • Preface
  • Acknowledgments
  • Contents
  • Summary
  • INTRODUCTION
  • THE LABORATORY INDUSTRY
  • THE CURRENT MEDICARE PAYMENT SYSTEM
  • GOALS FOR A PAYMENT SYSTEM
  • ASSESSMENT OF THE CURRENT MEDICARE PAYMENT SYSTEM
  • RECOMMENDATIONS
  • CONCLUSION
  • REFERENCES
  • 1 Introduction
  • ORIGINS OF THIS STUDY
  • STATEMENT OF TASK
  • THE IOM STUDY PROCESS
  • GOALS FOR A PAYMENT SYSTEM
  • CLINICAL LABORATORY SERVICES COVERED BY MEDICARE
  • THE MEDICARE PROGRAM
  • What Types of Laboratory Services Are Included in the Medicare Laboratory Fee Schedule?
  • ORGANIZATION OF THE REPORT
  • REFERENCES
  • 2 Background and Environmental Trends
  • BACKGROUND ON THE CLINICAL LABORATORY INDUSTRY
  • Sites of Service
  • Geographic Distribution
  • Size and Distribution of the Market
  • Trends in Expenditures for Laboratory Services
  • Financial Strength of the Laboratory Industry
  • MEDICARE PART B CLINICAL LABORATORY TRENDS
  • Medicare Part B Spending
  • ENVIRONMENTAL TRENDS
  • Regulatory Trends
  • Clinical Laboratory Improvement Amendments of 1988
  • Test Complexity and Laboratory Certification
  • CLIA's Impact on the Laboratory Industry
  • CLIA's Impact on Quality
  • Occupational Safety and Health Administration
  • MINIMIZING FRAUD, WASTE, AND ABUSE
  • Stark Amendments
  • OIG Investigations
  • Medical Necessity Review
  • PAYMENT TRENDS
  • Medicare Shift to Prospective Payment Systems
  • Growth of Managed Care
  • RESPONSE FROM THE INDUSTRY TO ENVIRONMENTAL TRENDS
  • Market Consolidation and Network Development
  • Growth of Hospital-Based Laboratory Outreach Programs
  • SUMMARY
  • REFERENCES
  • 3 Technology Trends in the Clinical Laboratory Industry
  • AUTOMATION
  • Preanalytic Stage
  • Analytic Stage
  • Postanalytic Stage
  • INFORMATION TECHNOLOGY
  • LABORATORY MEASUREMENT AND TESTING TECHNOLOGY.
  • Esoteric Tests
  • Genetic Testing
  • Pharmacogenomics
  • Nanotechnology
  • TECHNOLOGY'S EFFECT ON SITE OF SERVICE
  • Point-of-Care Testing
  • Home Testing
  • EFFECT ON CLINICAL LABORATORY STAFF REQUIREMENTS
  • SUMMARY
  • REFERENCES
  • 4 Description of the Current Medicare Payment System and Its Historical Roots
  • INTRODUCTION
  • THE FDA APPROVAL PROCESS
  • CODING POLICY
  • Coding Updates
  • Panel Codes
  • Codes for New Technology
  • Ambiguities in Code Use
  • CLAIMS PROCESSING
  • MEDICARE COVERAGE POLICY
  • National Coverage Decisions
  • Local Medical Review Policy
  • Claims Denials
  • Advanced Beneficiary Notice
  • Negotiated Rulemaking
  • MEDICARE PAYMENT POLICY
  • Early History of the Payment System
  • DEVELOPMENT OF THE CURRENT SYSTEM
  • ELEMENTS OF A PAYMENT SYSTEM
  • Type of Payment
  • Unit of Payment
  • Basis of Payment
  • Level of Payment
  • Panel Tests
  • Congressionally Set Test Payment Levels
  • Fee Level for New Technology
  • Updating Payments
  • Adjustments
  • Geographic Adjustment
  • Sole Community Hospital Adjustment
  • Base-Fee Adjustment
  • Inherent Reasonableness
  • Cost Sharing
  • EFFECT OF LABORATORY SPENDING ON PHYSICIAN PAYMENT
  • CONCLUSION
  • REFERENCES
  • 5 The Current System: How Well Does It Work?
  • BENEFICIARY ACCESS
  • FLEXIBILITY
  • TRANSPARENCY
  • VALUE
  • ADMINISTRATIVE SIMPLICITY AND EFFICIENCY
  • OTHER ISSUES OF CONCERN
  • Improving the Quality and Appropriate Use of Laboratory Services
  • Coding Process for Outpatient Laboratory Tests
  • Fraud, Waste, and Abuse
  • CONCLUSION
  • REFERENCES
  • 6 Alternative Payment Methodologies
  • INTRODUCTION
  • ELEMENTS OF A PAYMENT SYSTEM
  • Type of Payment
  • Definition
  • Discussion
  • Comparative Assessment
  • Unit of Payment
  • Definition
  • Discussion
  • Comparative Assessment
  • Basis of Payment
  • Definition
  • Discussion
  • Level of Payment
  • Definition
  • Discussion.
  • OTHER ISSUES IN PAYMENT SYSTEMS
  • Updating Payments
  • Adjustments
  • Cost Sharing
  • MAKING IMPROVEMENTS A REALITY
  • Designing Payment Policies
  • Implementing New Payment Policies
  • CONCLUSION
  • REFERENCES
  • 7 Recommendations
  • INTRODUCTION
  • CONCLUSION
  • REFERENCES
  • Acronyms and Glossary
  • ACRONYMS
  • GLOSSARY
  • APPENDIX A Acknowledgments
  • APPENDIX B Medicare Clinical Laboratory Payments: The National Limitation Amount and Its Relationship to Payment Amounts
  • APPENDIX C Study of Fees and Payment System Characteristics for Clinical Laboratory Services
  • EXECUTIVE SUMMARY
  • Study Methodology
  • Study Findings
  • STUDY OBJECTIVES AND DESCRIPTION OF STUDY METHODOLOGY
  • Background and Study Objectives
  • Payment Rate Determination Methodology
  • Selection of Payers
  • Selection of Clinical Laboratory Services
  • Additional Information Included in the Survey
  • CLINICAL LABORATORY PAYMENT RATES
  • Introduction
  • Clinical Laboratory Fee Data
  • Clinical Laboratory Capitation Data
  • Comparison of Fees
  • CHARACTERISTICS OF LABORATORY SERVICE PAYMENT SYSTEMS
  • Survey Approach
  • Laboratory Payment System Characteristics
  • REFERENCES
  • EXHIBIT C.1: SURVEY INSTRUMENT FOR STUDY OF PAYMENT RATES FOR LABORATORY SERVICES
  • Section I. Background and General Description of Laboratory Payment Methodologies
  • Section II. Fee-for-Service Plans
  • Section III. Capitated Plans
  • Section IV. Additional Comments
  • APPENDIX D Annual Volume of Laboratory Tests by Laboratory Type and Waived-Nonwaived Test Status, 1996-1998, 1999-Early 2000
  • APPENDIX E 1998 Medicare Carrier Denial Rates
  • APPENDIX F Committee Biographies.

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