Medicare’s Apathy on Pricing for Medical Diagnostic Tests to Hit Care

by | Published on Apr 2, 2013 | Healthcare News

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Medicare has stopped reimbursements for medical diagnostic tests, affecting hundreds of healthcare providers across the country.

Medicare’s had provided reimbursement benefits to big laboratory companies, diagnostic labs in academic establishments and smaller firms that do molecular diagnostic tests that help detect issues like cancer.

To link payment to value, Medicare had asked American Medical Association (AMA) to come up with specific medical codes for important molecular diagnostic tests. The AMA came up with 116 codes which became effective in 2011. However, Medicare updated to these molecular codes only at the last moment – in 2012. Medicare was supposed to set prices for these new codes. But nothing happened. Instead of coming up with a new system, the Centers for Medicare and Medicaid (CMS) wasted a full year and did largely nothing. The agency sat on its hands.

The failure to come up with a pricing policy for these diagnostic tests has resulted in many of these tests going unpaid. April 30th 2013 has been declared the deadline for Medicare contractors to submit their pricing policy for the year, but there is a lot of uncertainty regarding the methodology to be adopted.

Billing for Medicare and Medicaid has never been an easy task. There are many technicalities involved and as a busy healthcare provider you most likely find it difficult to submit accurate claims. Your best option is to rely on a professional medical billing and coding company. Besides submitting claims for all the conventional treatments provided, the right service provider can also handle the issues posed by new pricing policies and new codes. Competent medical billing and coding services can ensure customized, timely solutions for Medicare reimbursement.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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