Effective July 1, 2013 Aetna lowered its standard laboratory fee schedule, known as the Aetna National Contract Default. Health plans paying under this schedule will expect fees to reflect 45-50% of Medicare, on both the clinical and anatomic side of pathology reimbursement. To put this into perspective, the global reimbursement national rate for an 88305 after July 1, 2013 is $35.05, according to this fee schedule. Medicare’s national rate for the same service is $70.09, a rate already reflecting a 33% reduction in global reimbursement as of January 1st, 2013.
Through over 50 years of experience, APS has seen many changes in national fee schedules. Along with these changes come mistakes on the carrier’s part in applying the new rates to the correct contracted practices. APS utilizes our proprietary contract management to compare all payment activity with those rates negotiated with each carrier. If Aetna erroneously applies this reduced fee schedule to any client’s account, rest assured APS will identify all instances and work vigorously to collect underpayments and work with the carrier to ensure the issue does not continue. If you have any additional questions, please contact your Practice Manager.
In working through the wide variety of billing arrangements, APS found payments that we had been missing.