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Chapter 1.1 : Introduction

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Introduction, Page 1 of 2

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Abstract:

When the first edition of this handbook was published, regulatory billing compliance for laboratory tests was not a major laboratory issue. Most hospital laboratories generally performed services for their own inpatients (and, occasionally, affiliated outpatients), and tests were billed according to a formula established by the business office. In the setting of prospective payment (e.g., diagnosis-related groups), payment credit was allocated based on a different formula. Today, however, microbiologists must be aware not only of the scientific basis of infectiousdisease diagnostics but also of the costing, coding, billing, and reimbursement for individual tests for patients seen in a broad spectrum of health care settings with coverage by an enormous number of health care plans. Jargon previously unknown in the clinical laboratory, such as reflex testing, upcoding, downcoding, local coverage decision (LCD), and national coverage decision (NCD), is now so extensive that a glossary of common terminology is included in this section ( Appendix 1.1-1 ). The goal is to be reimbursed adequately for all appropriate work performed in a manner that is in compliance with all regulations.

Citation: Garcia L. 2010. Introduction, p 34-39. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch1.1
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References

/content/book/10.1128/9781555817435.chap1.1
1. Centers for Medicare and Medicaid Services. 2008. Medicare Program Integrity Manual. Centers for Medicare and Medicaid Services, Baltimore, MD. http://www.cms.hhs.gov/manuals/iom/ItemDetail.asp?ItemID=CMS019033.
2. Institute of Medicine. 2000. Medicare Laboratory Payment Policy: Now and in the Future. National Academy Press, Washington, DC.
3. Office of the Inspector General. 1998. Compliance program guidance for clinical laboratories. Fed. Regist. 63:4507645087.

Tables

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Table 1a

Terminology

Citation: Garcia L. 2010. Introduction, p 34-39. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch1.1
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Table 1b

Acronyms

Citation: Garcia L. 2010. Introduction, p 34-39. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch1.1

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