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CodeMap® 08/20/2020: OIG Report on Laboratory Test Expenditures 2018

CodeMap® Compliance Briefing: August 20, 2020


Editor's Welcome: Last week, the OIG published a report on Medicare expenditures for laboratory tests in 2018. The OIG performed this analysis for two reasons; one, 2018 was the first year that CMS used private payer reimbursement data to determine Medicare reimbursement amounts pursuant to PAMA; and two, PAMA requires the OIG to annually monitor and identify the top 25 tests based on Medicare spending. The report is surprising in that it demonstrates that Medicare paid $7.6 billion for lab tests in 2018, a $459 million increase over the $7.1 billion Medicare paid in 2017. Despite the fact that PAMA reduced Medicare reimbursement for more than 75% of the tests listed in the Medicare Clinical Laboratory Fe....

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