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Medicare clinical lab bidding demo

This article was originally published in The Gray Sheet

Executive Summary

CMS will soon announce the target region for its Medicare Clinical Lab Bidding Demonstration Project, as well as the date of a related bidder's conference, the agency says Oct. 9. The project is designed to assess the cost-saving potential of replacing Medicare's clinical laboratory fee schedule with prices based on the lowest bids from labs ("1The Gray Sheet" Aug. 13, 2007, p. 8). CMS has made three changes to the demo in response to comments received over the summer: Labs providing services exclusively to nursing home beneficiaries or those who receive home health services in the competitive bidding area will not be required to bid, but will be paid at the demonstration fee schedule rate; a non-winning lab may serve as a reference lab to those participating in the demo, but cannot bill Medicare directly; and the labs must bid on 303 Health Care Procedure Coding System (HCPCS) codes, representing the top 99% of tests paid for under the Part B Clinical Laboratory Fee Schedule. Various lab groups support legislation to quash the project ("2The Gray Sheet" Oct. 1, 2007, In Brief)

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