Test Pricing and Antitrust Laws

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The page below is a sample from the LabCE course Medicare Compliance for Clinical Laboratories. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Test Pricing and Antitrust Laws

  • It is not against the law for a laboratory to have different fee schedules for different billing situations. Most laboratories have one fee schedule for customers that must be billed individually (patients, insurance, Medicare) and one for customers billed monthly on an invoice type of statement (client or doctor billing).
  • The difference in price between the two schedules should be a reflection of the financial benefits of direct client billing.
  • Test prices should be determined by means of a financial analysis that includes such factors as cost, market value, and reasonable profit.
  • Contractually arranged pricing that results from negotiations with insurance and managed care companies should at least cover costs of testing.
  • Laboratories may not work together to fix or set prices in the market place.