Test pricing and antitrust from Medicare Compliance for Clinical Laboratories, presented by MediaLab

Sales and Marketing: Equipment, contracts, and pricing

Test pricing and antitrust

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 include 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.

Get online OSHA safety and compliance training for your clinical laboratory employees.

Learn more about laboratory continuing education for ASCP, AMT, NCA, and state renewal and recertification requirements »

Get information on laboratory safety and compliance courses for clinical and medical laboratories »