Tag Archives: Clinical Laboratories

Medicare Clinical Lab Fee Schedule Payments to Fall by $670 Million in 2018 Under Preliminary PAMA Rates

CMS has posted preliminary Medicare clinical laboratory fee schedule rates for 2018 – the first year rates will be based on private payer data under the Protecting Access to Medicare Act of 2014 (PAMA). CMS estimates that 2018 Medicare Part B payments will be reduced by about $670 million for calendar year 2018. In fact, … Continue Reading

Upcoming CMS Clinical Diagnostic Lab Test Advisory Panel Meeting to Consider Lab Test Rates

The Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests (CDLTs) is holding a public meeting on Monday, September 25, 2017.  The Panel will discuss calendar year 2018 clinical laboratory fee schedule codes for which CMS received no applicable information to calculate a Medicare payment rate.  The list of CDLTs that will be discussed during the … Continue Reading

CMS Announces Summer Meetings on 2018 Clinical Lab Fee Schedule Update

CMS has scheduled two days of meeting this summer on updates to the Medicare clinical laboratory fee schedule (CLFS) for 2018. First, the public meeting on payment amounts for new or substantially revised HCPCS codes being considered for Medicare payment under the 2018 CLFS will be held on July 31, 2017. This meeting also will … Continue Reading

Just Under the Wire, CMS Announces 60-Day Extension of PAMA Clinical Lab Reporting Deadline

The Centers for Medicare & Medicaid Services (CMS) has just announced that it is extending until May 30, 2017 the deadline for certain clinical laboratories to report to CMS private payor reimbursement information.  As required by the Protecting Access to Medicare Act of 2014 (PAMA) and its implementing regulations, this data will be used to … Continue Reading

CMS Releases 2017 Medicare DMEPOS and Clinical Lab Fee Schedules

 CMS has announced 2017 Medicare fee schedule rates for durable medical equipment (DME) prosthetic orthotics and supplies (DMEPOS) furnished in non-competitive bidding areas.  The calendar year 2017 DMEPOS update factor is 0.7 percent, although other specific coding and pricing policies are applied to numerous types of DMEPOS items, as detailed in a CMS transmittal. In … Continue Reading

CMS Posts Final 2017 Medicare Clinical Lab Payment Determinations

CMS has released the final 2017 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes, including determinations regarding whether CMS will use crosswalking or gapfilling to establish payment rates for specific tests. Under the final determinations, all tests reviewed for 2017 are being crosswalked. CMS also released the final national … Continue Reading

CMS to Host November 2 Call on Clinical Diagnostic Lab Test Payment System Data Reporting

CMS is hosting an educational call on November 2, 2016 to discuss reporting obligations under the June 23, 2016 Clinical Diagnostic Test Payment System final rule.  As previously reported, under the Protecting Access to Medicare Act (PAMA), certain laboratories must report data to CMS on private payor rates and volume of clinical laboratory tests, which … Continue Reading

New OIG Studies Reveal Clinical Lab Test Payment Trends and CMS’ Progress in Implementing PAMA

Last week, the OIG released two new studies analyzing what and how Medicare pays for clinical laboratory tests (“lab tests”). The first study, Medicare Payments for Clinical Diagnostic Laboratory Tests in 2015: Year 2 of Baseline Data, analyzed Medicare Part B claims data for lab tests performed in 2015 and reimbursed under the Clinical Laboratory … Continue Reading

CMS Issues Preliminary 2017 Medicare Clinical Lab Payment Determinations, Final 2016 Gap Fill Amounts

CMS has released the preliminary 2017 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes, including determinations regarding whether CMS will use crosswalking or gapfilling to establish payment rates for specific tests.  CMS will accept public comments on these preliminary determinations through October 2016.  Also, CMS has released the 2016 … Continue Reading

Congressional Hearings Focus on Health Policy Issues

A number of recent Congressional hearings have focused on health policy issues, including:  Senate Health, Education, Labor, and Pensions Committee hearings on laboratory testing in the era of precision medicine, and the safety of cosmetics. A House Judiciary Committee hearing on “Treating the Opioid Epidemic: The State of Competition in the Markets for Addiction Medicine.” … Continue Reading

CMS Posts PAMA Clinical Lab Fee Schedule Data Reporting Template and User Guide

In order to assist the clinical laboratory community in meeting new Medicare reporting requirements under the Protecting Access to Medicare Act of 2014 (PAMA), CMS has posted a Clinical Laboratory Fee Schedule Data Reporting Template and a “Quick User Guide” to the template.  By way of background, PAMA requires CMS to base Medicare clinical laboratory fee … Continue Reading

CMS Schedules Next Meeting of Advisory Panel on Clinical Diagnostic Laboratory Tests for September 12

CMS has announced that the next meeting date of the Advisory Panel on Clinical Diagnostic Laboratory Tests will be September 12, 2016.  The meeting is expected to cover: Payment options for routine chemistry tests that are currently paid as Automated Test Panels (ATPs) under the new payment system for clinical diagnostic laboratory tests effective January … Continue Reading

CMS Finalizes Changes to Medicare Clinical Lab Test Payment Policy, Pushes Back Effective Date to 2018

On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) is publishing a major final rule to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts, as required by the Protecting Access to Medicare Act of 2014 (PAMA). In an important change from the proposed rule, CMS will implement … Continue Reading

CMS Announces July 18 Public Meeting on 2017 Medicare Clinical Lab Fee Schedule

CMS has scheduled a July 18, 2016 public meeting on payment for new and substantially revised clinical diagnostic laboratory test codes for payment under the 2017 Medicare clinical laboratory fee schedule (CLFS).  The meeting also will address reconsideration requests regarding final determinations made last year. Registration will open on June 6, 2016, and the deadline for presenter registration and submission … Continue Reading

Extensive Medicare & Medicaid Funding and Program Integrity Provisions in Obama’s Released FY 2017 Budget Proposal

On February 9, 2016, the Obama Administration released its proposed fiscal year (FY) 2017 budget, which contains significant Medicare and Medicaid reimbursement and program integrity legislative proposals – including $419 billion in Medicare savings over 10 years. These proposed policy changes would require action by Congress, and Republican Congressional leaders have already voiced general opposition … Continue Reading

Upcoming Health Policy Hearings

Several Congressional hearings are scheduled next week and into December on health policy issues, including: A November 17 Senate Finance Committee hearing entitled “Physician Owned Distributors: Are They Harmful to Patients and Payers?” A November 17 House Judiciary Subcommittee on Regulatory Reform hearing on “The State of Competition in the Pharmacy Benefit Manager and Pharmacy … Continue Reading

House Energy & Commerce Panel Releases Draft Bill to Regulate Diagnostic Lab Tests, Schedules November 17 Hearing

The House Energy and Commerce Health Subcommittee has scheduled a November 17, 2015 hearing on the regulation of diagnostic tests and laboratory operations.   The hearing will feature FDA and CMS officials who will testify on “each agency’s respective responsibilities and areas of expertise in the regulation of diagnostic tests, as well as what their roles … Continue Reading

CMS Proposes Major Changes to Medicare Clinical Lab Test Payment Policy

On October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) published its long-awaited proposed rule to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts beginning January 1, 2017. CMS estimates that the new policy, which was mandated by the Protecting Access to Medicare Act of 2014 (PAMA), will … Continue Reading

CMS Releases Preliminary 2016 Determinations for New Clinical Lab Tests, Announces October 19 Open Meeting on Clinical Lab Payments

CMS has announced its preliminary 2016 clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes.  These preliminary determinations will be the subject of an October 19, 2015 meeting of the Advisory Panel on Clinical Diagnostic Laboratory Tests. The public may attend the meeting in-person (registration required), view via webcast, or listen … Continue Reading

OMB Reviewing CMS Proposed Rule on PAMA Clinical Lab Test Payment Policy

CMS is finally taking steps to implement the Medicare clinical laboratory payment reforms mandated by the Protecting Access to Medicare Act of 2014 (PAMA).  Under PAMA, CMS must base Medicare payment rates for clinical laboratory tests on private payor rates beginning January 1, 2017. The statute requires that CMS establish the parameters for the private … Continue Reading

First Meeting of Advisory Panel on Clinical Diagnostic Laboratory Tests on August 26, 2015

CMS has announced that the first meeting of the Advisory Panel on Clinical Diagnostic Laboratory Tests will be held on August 26, 2015. The Panel will recommend crosswalks for new laboratory codes, recommend an appropriate coding structure for drugs of abuse testing, and recommend crosswalks for such drugs of abuse testing. Registration for the meeting … Continue Reading
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