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OIG Report Details Medicare Payments for Top Lab Tests

by | Nov 7, 2016 | Essential, National Lab Reporter, OIG-nir, Reimbursement-nir

From - National Intelligence Report Medicare Part B paid $7 billion for lab tests in 2015, the same amount it shelled out in 2014. But 2015 Medicare payments for the top 25… . . . read more

Medicare Part B paid $7 billion for lab tests in 2015, the same amount it shelled out in 2014. But 2015 Medicare payments for the top 25 lab tests dipped slightly to $4.1 billion, as compared to $4.2 billion in 2014. These are among the key conclusions of a new report issued by the Office of Inspector General (OIG) as part of its Protecting Access to Medicare Act of 2014 (PAMA) mandate to monitor Medicare payments for lab tests in advance of the new payment system taking effect on Jan. 1, 2018.

The $7.0 billion paid for lab tests under the Clinical Laboratory Fee Schedule (CLFS) accounted for roughly 3% of all Part B payments made in 2015, according to the report. Where did that money go?

What Medicare’s $7 Billion in 2015 Lab Spending Went Toward

TestsBeneficiariesLabsProviders
474 million: number of tests billed

3.7: average number of tests received by beneficiaries in a day

24: average number of tests per day for top 1% of beneficiaries

27 million: Medicare beneficiaries that received at least one test

17: average number of tests per beneficiary

109: average number of tests per beneficiary among top 1% of beneficiaries

61,040: labs that received Medicare payments

$113,981: average payments per lab

$1.0 billion: payments made to the top three labs

612,812: providers that ordered lab tests

570: average number of tests ordered per provider

7,250: average number of tests ordered by top 1% of providers

Source: OIG “Medicare Payments for Clinical Diagnostic Laboratory Tests in 2015

For further discussion of the OIG’s report and what the agency has to say about payment trends, fees paid for the top 25 tests and potential impact of PAMA see the Oct. 28, 2016 issue of National Intelligence Report.

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