Spectra Laboratories understands today's complex regulatory environment, and is always looking for ways to simplify the reimbursement processes for our customers. On this page, you'll find relevant, up-to-date reimbursement information on clinical laboratory tests for Medicare ESRD beneficiaries.
Understanding the CMS ESRD Prospective Payment System (PPS)
Effective January 1, 2011, Medicare changed the manner in which it reimburses dialysis facilities for ESRD related items and services. Lab services are one of the items most significantly impacted by this change.
The new CMS ESRD PPS bundles additional items and services, including most laboratory services, into a single payment to the dialysis facility. For more information visit http://www.cms.gov/ESRDPayment/.
Coverage policy variations
Certain laboratory tests are subject to coverage policies that define, and may limit, the medical conditions that justify the test. These coverage policies may be National Coverage Determinations (NCD), which apply to all Medicare Contractors throughout the country, or Local Coverage Determinations (LCD), which apply only to the region in which the lab testing is performed.
Our Milpitas, California laboratory is subject to local policies issued by Noridian. Lab tests performed by our Rockleigh, New Jersey laboratory are subject to local policies issued by Novitas.
Local and national coverage and payment policies for clinical laboratory services are added and revised periodically. Spectra Laboratories regularly participates in forums to advocate for payment policies and rules that recognize the special needs of ESRD beneficiaries, and consider the critical role laboratory services play in the delivery of health care.
Reimbursement bulletins and guidelines
Spectra Laboratories complies with federal and state regulations regarding the billing and payment of clinical laboratory services furnished to ESRD beneficiaries.
Helpful links and Web sites
> National Coverage Determinations for clinical laboratory services published by CMS (Centers for Medicare and Medicaid Services):Medicare and Medicaid general overview
> Medicare Benefit Policy Manual
> ICD 9-CM and ICD 10 Codes