CQW Panacea-re-brand-rev3

Laboratory

For the Week of April 21, 2014

Question:

In your answer last week, you stated that Congress authorized HHS to develop a process to adjust lab payments based on market rates. Exactly what is this about?

Answer:

Congress limited cuts to diagnostic tests on the clinical laboratory fee schedule (CLFS) by tying pricing and payment to market-based private-sector payments. Labs would report their private-sector payment rates (with certain exclusions such as capitation) and volume of tests performed to the secretary of the Department of Health & Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS) would use this data to establish Medicare payment rates.

The legislation gives HHS until June 30, 2015, to publish a rule governing the data-collection requirement, and labs that receive most of their payments via CLFS or the MPFS would be required to start submitting data January 1, 2016, and every three years thereafter. However, information on “advanced” lab tests would be reported annually.

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