Just when you thought you knew the lab standards . . .
HCFA panel forming to negotiate new lab rules
On June 3, the Health Care Financing Administration announced the creation of a negotiated rulemaking committee to write new national coverage and administrative policies for clinical diagnostic laboratory tests, as required by the Balanced Budget Act of 1997.
The rulemaking committee will include representatives from HCFA and industry and provider groups affected significantly by the proposed rule, along with neutral facilitators.
Representing HCFA will be Grant Bagley, director of the coverage and analysis group in HCFA's Office of Clinical Standards and Quality.
The group's stated goals are to promote program integrity, national uniformity, and administrative simplicity.
Specific issues on the committee's agenda include:
- beneficiary information to be submitted with each claim or order for laboratory tests;
- medical conditions under which a laboratory test is considered reasonable and necessary;
- appropriate use of procedure codes in billing for a laboratory test;
- medical documentation to be required by a Medicare contractor when a claim is submitted for a lab test;
- record-keeping requirements and related physician obligations;
- procedures for filing claims and providing remittances by electronic media;
- limits on coverage frequency for the same tests performed on the same individual.
The committee will only deal with these seven issues, says HCFA.
Groups included on the negotiating committee include: American Association of Bioanalysts, American Association for Clinical Chemistry, American Association of Retired Persons, American Clinical Laboratory Association, American Health Information Management Association, American Medical Association, American Medical Group Association, American Society of Clinical Pathologists, American Society of Internal Medicine, College of American Pathologists, Clinical Laboratory Management Association, Health Industry Manufacturers Association, Medical Group Management Association, and National Medical Association.
HCFA has set a deadline of six months from the group's first meeting, on July 13-15, for the committee to complete work on the proposed rule.
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