Last month I had a routine annual physical and my internist ordered a number of blood tests. (I'll jump past any discussion what's necessary or not, and I didn't ask the phlebotomist or the internist what they were ordering or drawing that morning). I'm just sharing some examples of charges vs payments.
Charges per test ran from $33.67 to $241.84, while payments ran from $6.97 to $31.87.
What BCBS paid, relative to the Medicare lab fee schedule, was always 108% of CMS. That is, whether the lab announced a charge of $30, $50, or $90, BCBS paid them at 108% of CMS.
Even though the charge did not seem to drive payment (since payment was locked to a % CMS), the charges were variably 5.2X to 8.2X the CMS fee schedule.
The whole driver of PAMA law and rates for CMS lab services was the belief that large health plans and large labs had substantially lower rates that Medicare CLFS, but in this case, a large plan and large lab are contracted at 108% the Medicare rate.
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