Laboratory end-stage renal disease testing

The Department of Health and Human Services, Office of Inspector General has incorporated end-stage renal disease (ESRD) into its 1999 Work Plan. Specifically, they will focus on identifying inappropriate Medicare payments for clinical laboratory services and their medical appropriateness. Under Medicare's composite rate reimbursement system, certain laboratory tests at established frequencies are covered under the composite rate. Any additional tests billed that are beyond the established frequencies must be supported by medical necessity. When billing laboratory tests for ESRD patients, it is important to know what tests are covered and at what frequencies under the composite rate. It also is important to understand the use of the 50/50 rule for determining whether automated multichannel tests are billable. This article reviews these details and provides insight into how laboratories should apply these rules when billing for ESRD testing.