Unpaid for Molecular Tests, Some Labs Are Closing

THERE IS GREAT FRUSTRATION ACROSS THE LABORATORY MEDICINE PROFESSION on the subject of getting paid for claims covered by the new Tier I and Tier II molecular test CPT codes. We are now in the fifth month of the year and pathologists are still waiting for an acceptable resolution to this situation.

Last week in New Orleans, at the Executive War College on Lab and Pathology Management, speakers gave plenty of attention to this topic. Simply put, the Medicare program was scheduled to implement pricing for these new CPT codes at the beginning of 2012. Program officials delayed that until January 1, 2013, in order to have the time they needed to develop appropriate pricing.

As most of you know, when January 1, 2013, arrived, Medicare contractors across the nation were unprepared. That was equally true of most private health insurance plans, since they often follow Medicare’s lead when establishing their own coverage and reimbursement guidelines. As a result, the vast majority of laboratories performing molecular tests covered by these CPT codes have gone unpaid for a full four months!

The financial chaos caused by this situation is without precedent. THE DARK REPORT is learning about laboratory testing companies that have closed their doors already as a result, in some significant part, of having gone unpaid for the molecular tests they have performed on behalf of patients, but for which Medicare contractors have yet to issue payment. We hope to report on the specifics of these cases in upcoming issues.

In the meantime, every clinical laboratory and pathology group directly affected by the four-month non-payment of these molecular test claims should be actively communicating with their elected officials. At the Executive War College last week, leaders from the American Clinical Laboratory Association, the California Clinical Laboratory Association, and the National Independent Laboratory Association were asking lab executives and pathologists to contact their respective offices and provide information about the non-payment of the molecular test claims they have submitted.

These laboratory trade associations are preparing lists of labs affected by this situation and will use them in lobbying and education efforts. An impressive number of labs at the Executive War College provided details of their situation, so it is a lengthy list that will grow even larger as labs like yours respond.


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