FRIDAY COMPLIANCE BRIEFING: 12/6/2002
This week we will focus on a recent CMS Program Memorandum (PM) explaining the implementation of the 2003 Laboratory Fee Schedule. In the PM, CMS provides important new guidance on exactly how Medicare carriers should set reimbursement amounts for gap-filled tests. These new rules should force Medicare carriers to rely on facts rather than arbitrary assumptions as has happened in the past. Remember, we rely on your comments and questions for topics of future Friday Compliance Briefings, so feel free to foward any ideas and/or concerns.
Charles B. Root, Ph.D.
BACKGROUND: CROSSWALKING AND GAP-FILLING
When new CPT codes are added to the Medicare Laboratory Fee Schedule, reimbursement amounts are developed using one of two methods, either crosswalking or gap-filling. If another code already exists that is sufficiently similar to the new code in terms of test cost, technology, and clinical use, CMS determines the payment amount by crosswalking the code. This means the new code....
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