Who bills Medicare for referral tests

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From:Priscilla <pdelvent@wyoming.com> (by way of histonet)
To:histonet <histonet@magicnet.net>
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I've been wading through the quote from the national intelligence
report about how to bill for referral tests.

I don't understand why the hospital should be the one to bill Medicare when
they will eventually receive a bill from the reference lab for the full
price of the test.  Most of the time the reason a test is sent out is
because that particular test is not ordered frequently enough to have the
overhead of keeping reagents required for the test or to justify a
technicians time to run.   Hospital laboratorys don't  order the testing
whether done in house or referred.  A physician orders the tests.  Why
should the hospital be put in a position to pay full price on a test that
someone else has ordered, someone else has run and be reeiembursed at a
fraction of the cost of the test, sometimes even lower than it costs to run
the test, not even including the cost of packaging raw material to be sent
to the lab? (Of course, I don't think anyone should have to be reeiembursed
in that manner, even reference labs.)

In the paragraph that talks about the 70/30 rule--how is that percentage
decided?  On an average from the previous year?  And how would a person
know when that ratio has been exceeded?

In the paragraph that talks about the lowest of three possible rates:  Who
is the carrier lab?  What is meant by the national limitation amount and
who sets that?  What is meant by median?  I believe the provider would be
the referring lab.

I hope I don't bore with these questions, but a person will never learn if
he or she doesn't ask the questions.

Cheers!  Priscilla in Central Wyoming

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