For the report, OIG analyzed claims data for lab tests CMS paid under Medicare’s Clinical Laboratory Fee Schedule. The agency found the top 25 tests Medicare paid for totaled $4.3 billion in 2016. This represented 60 percent of all payments, and more than half of payments for the top 25 tests went to 1 percent of labs.
“Changes in the Medicare payment rates for these 25 tests could have a significant impact on overall Medicare spending for lab tests when the new payment system for lab tests goes into effect in 2018,” OIG said. “The information presented here will be useful in monitoring the effects of changes to Medicare’s payment system for lab tests.”
In addition, the top six tests totaled $2.4 billion in 2016. This is consistent with the previous two years.
This is the third report OIG issued since 2014 to monitor baseline data of Medicare payments for lab tests. Medicare will change how it sets payment rates for clinical diagnostic laboratory tests in 2018. The change will introduce rates based on current charges in the private healthcare market.
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