Date of Award
2024
Embargo Period
4-3-2024
Document Type
Dissertation
Degree Name
Doctor of Health Administration
Department
Health Administration
College
College of Health Professions
First Advisor
Daniel L. Brinton
Second Advisor
Kit N. Simpson
Third Advisor
Zahi R. Jurdi
Abstract
Objective: To quantify missed reimbursements associated with specific CPT codes for Laboratory Developed Tests (LDTs) via polymerase chain reaction (PCR) in the United States during 2021.
Study Design: Quantitative, retrospective observational study to identify the dollar amount of missed reimbursements associated with 19 specific CPT codes billed for Medicare patients who had LDTs performed via PCR in the United States in 2021.
Data Sources: 19 specific CPT codes from Medicare and Commercial patients with LDT PCR testing performed using 2021 Meridian MarketScan data.
Key Results: Medicare represented 1.7% of the sample size with a potential lost revenue of $1M where Medicare reimbursed higher per CPT code when claims were paid, but had a higher zero dollar payment rate when compared to Commercial claims for the same 19 CPT codes.
Recommended Citation
Hartig, Summer, "Financial Implications Associated with Laboratories Performing Laboratory Developed Tests For Medicare and Commercial Patients" (2024). MUSC Theses and Dissertations. 842.
https://medica-musc.researchcommons.org/theses/842
Rights
Copyright is held by the author. All rights reserved.