CHA News Article

CMS Announces Enforcement Discretion for New Date of Service Policy for Certain Lab Tests

The Centers for Medicare & Medicaid Services (CMS) announced last week that it will exercise enforcement discretion until Jan. 2, 2019, for its new laboratory date of service exception policy for advanced diagnostic laboratory tests (ADLTs) and molecular pathology tests. The exception to the date of service rule for tests subject to this policy requires the laboratory performing the test to bill Medicare directly and prohibits the hospital from billing for these tests. While the rule was effective Jan. 1, CMS did not instruct the Medicare administrative contractors (MACs) to implement the new policy until July 2. On or after July 2, MACs are required to implement the new policy and may make payment adjustments for claims with dates of service on or after Jan. 1, and before July 2, that were not processed and paid consistent with the new policy.

During the six-month period of enforcement discretion, hospitals may continue to bill for ADLTs and molecular pathology tests that would otherwise be subject to the new laboratory exception. Clinical laboratories performing the test may also bill during that period, but may not duplicate billing by the hospital. Additional information — including a list of molecular pathology tests and ADLTs subject to the new policy and a frequently asked questions document – is available on CMS’ website.