January 2007
Sidebar: Competitive Bidding Structure
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There will be two demonstration sites. The demos will last three years and will have staggered starts.
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The sites will be chosen based on the beneficiaries who live within comp-etitive bidding areas (CBAs) and not based on a laboratory’s location.
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The project excludes hospital inpatient and outpatient testing, as well as physician office lab (POL) testing.
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The project will include tests offered by independent labs, as well as nonpatient testing by hospitals and POLs.
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The project will cover all laboratory tests paid for under Medicare Part B clinical lab fee schedule with the exception of Pap smears, colorectal cancer screening tests, and new tests added to the lab fee schedule during the course of the demonstration.
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Laboratories that have more than $100,000 in annual Medicare test payments in CBA are required to bid.
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Laboratories that have less than $100,000 in demo test annual payments are not required to bid, but will be paid for demo tests provided to beneficiaries residing in the CBA at the competitively bid fee schedule. Annual payments are capitated.
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Labs that participate in bidding but do not win will not be eligible for Medicare reimbursement for demo tests provided to beneficiaries residing in the CBA.
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Laboratories that are required to bid but do not participate in the bidding will be ineligible for Medicare Part B reimbursement for demo tests provided to beneficiaries residing in the CBA.
- Winning laboratories will be paid under one competitively set demonstration Medicare Part B clinical laboratory fee schedule for lab tests provided to beneficiaries living in the demo area.
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January 2007 - Table of Contents
