Medicare has retained the automated, multichannel fee schedule for reimbursement purposes. Last year’s fees have been updated to yield the 1998 fee schedule (Table 2 )for automated, multichannel tests.
Reimbursement for the new automated, multichannel test panel codes is based on the number of automated tests in each panel.
Medicare carriers have been instructed by HCFA to pay for all combinations of new and existing automated, multichannel test panels and single automated tests starting January 1, 1998, according to the following rules.
Carriers are to:
Step 1: Unbundle each panel into automated and nonautomated tests; Step 2: Eliminate all duplicate tests resulting from overlapping panel test compositions; Step 3: Rebundle all remaining automated tests together and pay according to the updated automated, multichannel fee schedule (see above); and Step 4: Pay all nonautomated tests individually based on the applicable laboratory fee schedule.
Although carriers have been instructed to install edits to accomplish the proper rebundling and payment for unbundled claims, it remains to be seen how accurate their reimbursement will be. It would be wise to monitor payments and Explanation of Benefits summaries for all automated tests and panels to ensure that payments are correct. If a carrier does not reimburse correctly for the tests submitted and overpays and the provider does not refund an overpayment, Medicare at a later date may accuse the provider of making a False Claim. Likewise, if the carrier underpays, the provider needs to refile the claim to receive proper payment. Thus, it would be wise to monitor all payments and promptly refund or refile to make sure that no liability is incurred for overpayments and that no payments are less than they should be.