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CodeMap® 04/01/2011: Genetic Testing Demonstration

CodeMap® Compliance Briefing: 04/01/2011

Editor's Welcome:

Complex and expensive genetic tests for guiding cancer treatment and other therapy are often performed on tissue obtained from inpatients undergoing surgery for other procedures. Since the date of service for laboratory tests is defined as the date the specimen is obtained, the cost of such tests is usually considered part of the DRG payment, and can not be separately billed. Considering the high costs of such testing, Medicare's current reimbursement policies represent a financial burden to many hospitals that could adversely affect patient's quality of care. As part of the Affordable Care Act, Congress created a demonstration project designed to see if paying for such tests outside of the DRG will result in better outcomes, and save money in the long run. Today we will discuss the details of this new demonstration project.


Gregory Root, Esq.

New Date of Service Rules for Inpatient Genetic Tests

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