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 composite rate payments
Laboratory services provided to ESRD beneficiaries are subject to a number of complex rules by Medicare and other payers.
Medicare's composite rate payment to the dialysis facility includes certain routine laboratory tests performed at specified frequencies. Eligible tests have not changed since 1983. Composite rate testing must be billed by Spectra to the dialysis clinic. Additional lab tests may be separately billed by Spectra to Medicare if proper documentation of medical justification is provided.
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 National Heritage Insurance Company (NHIC). Lab tests performed by our Rockleigh, New Jersey laboratory are subject to local policies issued by National Government Services.
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. As part of our commitment to educate you on these requirements, we are pleased to provide the following Medicare reimbursement schedules for your review:
* 2006 Medicare Reimbursement Schedules are valid through 2008.
These documents contain the amounts that Medicare currently pays for clinical laboratory services performed by Spectra Laboratories.
The following booklets include the National and Local Coverage Determinations applicable to clinical laboratory services ordered from Spectra Laboratories. Also included in these publications is important information on Medicare's ESRD laboratory billing requirements as well as guidelines for the proper reporting of diagnosis codes.
Helpful links and Web sites
Spectra Laboratories suggests you refer to the Web sites below for the most current information regarding Medicare's payment and coverage of clinical laboratory services.
