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What the CAP says

Proposed rule takes ‘excessive’ to extreme

December 2003
Karen Southwick

Following are the key points in the CAP’s comment letter to the Office of Inspector General opposing the proposed rule that would amend OIG excessive claims submission exclusion regulations (68 FR 53939, Sept. 15, 2003).

  • Non-Medicare clinical laboratory service fees are, on average, higher than Medicare fees, thus negating the need for regulations addressing excessive charges.
  • Because laboratory payments have consistently been revised to reflect market conditions, there is no reason to impose additional requirements on laboratories.
  • Reasonable and fair business practices sometimes justify higher Medicare payment for laboratory services.
  • The methodologies to comply with the proposed definitions of "substantially in excess" and "usual charges" will be administratively burdensome and, in some cases, impossible to implement.
  • The proposed rule will lead to major upheaval of existing relationships with Medicare and non-Medicare contracts, negatively impacting patient access and care.
  • The definition of the 120 percent threshold to define substantially in excess is not based on objective evidence.
  • There is no reason to expand the OIG proposal to include services on the physician fee schedule.

Karen Southwick is a writer in San Francisco.