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Clinical Chemistry 44: 1701-1712, 1998;
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(Clinical Chemistry. 1998;44:1701-1712.)
© 1998 American Association for Clinical Chemistry, Inc.

Clinical Chemistry Forum

Earning your keep: succeeding in laboratory reimbursement

Donald S. Young

   Introduction
 
The seventh Clinical Chemistry Forum of the American Association for Clinical Chemistry was held in Baltimore, Maryland, on December 4 and 5, 1997. Clinical Chemistry Fora have been oriented to addressing the management issues affecting clinical chemists and the clinical laboratory field. In this way, they complement the AACC's targeted conferences on new technology (Oak Ridge) and applications (A.O. Beckman). The theme for the 1997 Forum was reimbursement under the difficult conditions imposed by compliance with the new regulations associated with documentation of medical necessity for provided services. The Forum brought together representatives of the government as well as the independent and hospital clinical laboratory industries.

As part of its objective of disseminating information to the many members of the AACC and other scientists who were not able to attend the Forum, the AACC is pleased to publish here a summary of the presentations delivered at the meeting. These were compiled from a transcript of the presentations as well as the handout material provided by the speakers. In addition to the 13 summaries, the full texts of the presentations by Dr. Charles Root and Dr. Thomas Hoerger are included. I accept responsibility for the summaries, which were not reviewed by the authors. They do not reflect the overall excellence of the meeting or the extensive interaction between the speakers and the audience, which created the exciting forum that was the intent of the meeting.


   HCFA's Perspective
 
In her presentation, Juliette Jenkins of the Laboratory Policy Division, Health Care Financing Administration (HCFA),1 provided the following information about how her agency is helping to implement the changes in Medicare documentation requirements mandated by the Balanced Budget Act of 1997 (BBA).

Section 1862 of the Social Security Act requires that Medicare pay only for reasonable and necessary tests and services; Section 1833e of the Social . . . [Full Text of this Article]


   Carrier/Intermediary Perspective
 

   The Commercial Laboratory Perspective
 

   The Outlook for Hospitals
 

   Ambulatory Payment Classifications: What the Future Holds for Laboratories
 

   Medicare Part B Reimbursement
 

   The New ICD-10 Codes: What You Need to Know
 

   How to Bid, Evaluate, and Implement a Capitated Contract
 

   Practical Tips for Surviving under Managed Care
 

   What are Managed Care Organizations Looking For from Laboratories?
 

   Fraud and Abuse: The Enforcer's Perspective
 

   Medicare Audits–Two Stories: An Inspector's and the Inspected Laboratory's
 
the inspector

   Medicare Audits–Two Stories: An Inspector's and the Inspected Laboratory's
 
the laboratory

   Footnotes
 





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