Medicare Compliance & Reimbursement

 New Bill Jeopardizes Ove $18 Billion in Lab Revenues Just when labs thought it was safe to go back in the water, the copayment sharks have begun circling once again, with their eyes still set on labs' financial limbs. Less than six weeks ago, House and Senate conferees agreed to drop from a tax relief bill a provision which would have required a 20-percent copayment and deductible from Medicare beneficiaries seeking clinical laboratory services. But the battle over copayments didn't end there, as the provision found its way into the Senate's version of S.1, the "Prescription Drug and Medicare Improvement Act of 2003." The Senate June 27 passed this Medicare reform legislation with a 76-21 bipartisan vote. While the Senate may have approved a devastating 20-percent coinsurance requirement, the House version - which passed with a razor-thin vote of 216-215 - did not include copay language, reports Jeffrey Boothe, an attorney with Holland & Knight in Washington who also serves as outside counsel to the Wayne, PA-based Clinical Laboratory Management Association. Differences between the Senate and House versions of the bill now will be ironed out in a lengthy conference, predicts Boothe. "The way these conferences work is that everything hangs on everything else, so nothing is ever final until they finally report a bill out of conference," he states. And given both the extensive scope of the prescription drug bill and the fact that laboratory co-payments act as "a linchpin to the overall financing of the bill," Boothe suspects the copay issue will be lingering until the very end. This "financial linchpin" status of lab copays in the Senate's version is largely the work of Senate Finance Committee Chairman Charles Grassley (R-IA) and his provision to increase rural health care benefits. "The way that Senator Grassley was able to pay for the expansion of rural health benefits was on the back of clinical laboratories through the co-pay provision," Boothe tells MLR. The 20-percent laboratory copayments would be expected to generate $18.6 billion in savings over the next 10 years to offset the costs of expanding rural health care. The Senate July 7 announced that its conferees for the bill would include Senate Majority Leader Bill Frist (R-TN) and Senate Minority Leader Tom Daschle (D-SD), as well as Sens. Max Baucus (D-MT), John Breaux (D-LA), Grassley, Orrin Hatch (R-UT), Jon Kyl (R-AZ), Don Nickles (R-OK), and John D. Rockefeller IV (D-WV). The House July 14 named Reps. Marion Berry (D-AR), Michael Bilirakis (R-FL), Tom DeLay (R-TX), John Dingell (D-MI), Nancy Johnson (R-CT), Charles Rangel (D-NY), Billy Tauzin (R-LA), and Bill Thomas (R-CA) as its conferees.    What Labs Stand to Lose So what does all of this mean to a [...]