CMS switches up Medicare clinical lab test payments with proposed rule
- Last Friday, the Centers for Medicare & Medicaid Services announced a new proposed rule requiring clinical laboratories to report on private insurance payment amounts and volumes for lab tests.
- This data will be used to determine Medicare’s payment for lab tests beginning January 1, 2017.
- The rule will be published in the Federal Register on Oct. 1. The agency will take comments until Nov. 25.
CMS is at it again! The agency is taking the next steps necessary implementing the Protecting Access to Medicare Act of 2014.
Medicare’s current fee schedule for lab tests has remained mostly unchanged since first adopted in 1984. According to CMS, Medicare pays about $8 billion a year for clinical diagnostic lab tests. The new system will be updated every three years for clinical diagnostic laboratory tests (CDLTs) and every year for advanced diagnostic lab tests (ADLTs) to reflect market rates paid by private payers.
Under the proposed rule, certain laboratories would be required to report private payor rates and volume data if they receive at least $50,000 in Medicare revenues from laboratory services and more than 50% of their Medicare revenues from laboratory and physician services.
Laboratories would collect private payor data from July 1 through December 31 and report to CMS by March 31, 2016. CMS will post the new Medicare rates by November 1, 2016; effective January 1, 2017.
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