CHA News Article

CMS Issues Proposed Rule Revising Medicare Payments for Clinical Lab Tests

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule, which would revise the Medicare payment system for clinical diagnostic laboratory tests and implement other changes as required by the Protecting Access to Medicare Act of 2014. Under the proposed rule, certain “applicable laboratories” would be required to report private payer rate and volume data if they receive at least $50,000 in Medicare revenues from laboratory services and more than 50 percent of their Medicare revenues from laboratory and physician services. Notably, in a fact sheet on the proposed rule, CMS said it does not expect hospital laboratories to meet the definition of an applicable laboratory subject to the reporting requirements. Applicable laboratories would collect private payer data from July 1, 2015 through Dec. 31, 2015, and report it to CMS by March 31, 2016. CMS would post the new Medicare rates by Nov. 1, 2016 for lab tests beginning Jan. 1, 2017. CHA is currently reviewing the proposed rule. Comments are due Nov. 25 by 2 p.m. (PT).