Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017
From - G2 Compliance Advisor According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in… . . . read more
According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion Medicare paid in 2016 but little changed over the entire four years of the baseline period. The table below shows where that money went.
How Medicare Spent Its $7.1 Billion for Lab Tests in 2017
| Tests | Beneficiaries | Labs | Providers |
|---|---|---|---|
| 433 million: total tests billed 3.4: average number of tests received by beneficiaries per day 17: average number of tests per day for top 1% of beneficiaries |
28 million: beneficiaries that received at least one test 16: average number of tests per beneficiary 86: average number of tests per beneficiary among top 1% of beneficiaries |
56,859: labs that received Medicare payments $125,388: average payments per lab $1.1 billion: payments to top 3 labs |
655,771:providers that ordered lab tests 466: average tests ordered per provider 5,964: average tests ordered by top 1% of providers |
Source: OIG, “Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017“
What Medicare Paid for Top 25 Lab Tests
The OIG report includes detailed analysis of the 25 most frequently ordered lab tests. While the top 25 tests always generate the lion’s share of payments, that trend was even more pronounced in 2017:
Payments for Top 25 Lab Tests 2014-2017
| Year | Total | Percentage of All CLFS Payments |
|---|---|---|
| 2017 | $4.5 billion | 64% |
| 2016 | $4.3 billion | 63% |
| 2015 | $4.1 billion | 58% |
| 2014 | $4.2 billion | 59% |
Other Report findings for the top 25:
- 17 of the top 25 tests have been in the top 25 for all four years of the review;
- The top five tests accounted for $2.2 billion, or 30% of all payments for lab tests in 2017;
- The rankings of the top five tests haven’t changed in four years;
- One percent of labs (272 out of 27,171 labs) received 55% of all Medicare payments for the top 25 lab tests in 2017.
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