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The Centers for Medicare & Medicaid Services (CMS) has issued revised guidance for laboratories that are required to report private payer data for laboratory tests under the clinical laboratory fee schedule (CLFS). In response to advocacy from CHA, CMS revised its guidance for hospital outreach laboratories on reporting applicable information attributed to non-patients.
Specifically, CMS removed information included in earlier guidance that would have been burdensome for hospital outreach laboratories, requiring them to identify, collect, and report on separately payable private payer rates for payers that do not require the use of Form CMS-1450 14x Type of Bill (14x TOB).
CHA continues to urge any hospital with a laboratory that bills Medicare on a 14x TOB to carefully review the guidance to determine if it meets the definition of applicable laboratory and is subject to CLFS private payer reporting requirements. Additional information is available on CMS’ website.
