Root C B
Venture Resources, Barrington, IL 60010, USA.
Clin Chem. 1998 Aug;44(8 Pt 1):1713-27.
Medicare will continue to increase its efforts to cut spending through aggressive review of claims and the use of new fraud and abuse regulations. Providers must be especially careful to provide correct procedure codes that define precisely what services have been provided and accurate diagnosis codes that link those procedures or tests to an appropriate diagnosis. Medicare reimbursement rules for clinical laboratory procedures are explained, including the proper use of procedure and diagnosis codes. Coding and payment for new automated test panels are discussed, as well as the economic consequences of using smaller panels. Medicare coverage requirements, including medical necessity, are described, as well as the proper use of advance beneficiary notices and the Medicare appeals process.
医疗保险将继续加大力度，通过对索赔进行积极审查以及使用新的欺诈和滥用规定来削减开支。医疗服务提供者必须格外小心，提供准确的程序代码，精确界定所提供的服务内容，以及准确的诊断代码，将这些程序或检查与适当的诊断联系起来。文中解释了医疗保险对临床实验室程序的报销规则，包括程序和诊断代码的正确使用。讨论了新的自动化检测组合的编码和支付问题，以及使用较小检测组合的经济后果。描述了医疗保险的覆盖要求，包括医疗必要性，以及预先受益人通知书的正确使用和医疗保险上诉程序。
