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Labs with questionably high billing for additional tests alongside COVID-19 tests warrant further scrutiny
Labs with questionably high billing for additional tests alongside COVID-19 tests warrant further scrutiny
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- Author(s):
- Maxwell, Ann, (Deputy Inspector General for Evaluation and Inspections), author
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, December 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Clinical Laboratory Techniques -- economics
Costs and Cost Analysis
COVID-19 Testing -- economics
Insurance, Health, Reimbursement
Medicare Part B
United States - Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. Medicare Part B spending on COVID-19 lab tests increased steadily between spring 2020- when Medicare first started paying for these tests-and the end of that year. Preliminary analysis of Medicare Part B claims data indicated that some diagnostic testing laboratories billed for other diagnostic tests-such as individual respiratory tests (IRTs), respiratory pathogen panels (RPPs), genetic tests, and allergy tests-along with COVID-19 tests. We refer to these four types of tests billed with COVID-19 tests as add-on tests. Although it is not unusual for labs to bill for COVID-19 tests and other diagnostic tests on the same claim, certain billing patterns-such as a high volume of or high payments for add-on tests-raise concerns of potential waste or fraud. How OIG Did This Review. We performed outlier analysis to identify labs that billed for add-on tests at questionably high levels compared to other labs that billed for COVID-19 tests. We identified two kinds of outlier labs: (1) those for which add-on tests constituted a high proportion of each lab’s total number of tests, and (2) those for which add-on tests constituted a high proportion of each lab’s total payments for tests. We examined all Medicare Part B claims paid for COVID-19 tests during 2020, and for the following types of add-on tests: IRTs, RPPs, genetic tests, and allergy tests.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (16 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918681584006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918681584006676