Updates by Reed Smith on U.S. legislative & regulatory developments affecting the health care industry
The Centers for Medicare & Medicaid Services (CMS) has posted the final Medicare clinical laboratory fee schedule (CLFS) rates for 2020. The files reflect updates announced in a December 13, 2019 CMS transmittal, which also discusses payment policies for new CLFS codes effective January 1, 2020.
As reported previously, the final fiscal…
Preliminary 2020 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes are now available for review. For each code, the Centers for Medicare & Medicaid Services (CMS) announces whether it intends to use crosswalking or gapfilling to establish the payment rate, along with the agency’s rationale for…
The Centers for Medicare & Medicaid Services (CMS) has scheduled a June 24, 2019 public meeting on calendar year (CY) 2020 Medicare Clinical Laboratory Fee Schedule (CLFS) payments for new or substantially revised clinical lab codes. Specifically, the June meeting will provide an opportunity for the public to submit comments on the appropriate basis —…
On January 22, 2019, CMS is hosting a “refresher call” on Medicare requirements for certain clinical laboratories to report private payor rates and volume data for clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS). Data collected during the period of January 1, 2019 and June 30, 2019 will be used to…
CMS has finally posted the Medicare clinical laboratory fee schedule (CLFS) rates for 2019, which are based on private payer data as mandated by the Protecting Access to Medicare Act of 2014 (PAMA). The files reflect payment rate changes announced in a December 14, 2018 CMS transmittal, which also discussed policy changes including …
CMS has released its final 2019 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes. Specifically, CMS finalized the basis for establishing the payment rate (crosswalking or gapfilling), along with the agency’s rationale for the decision.
CMS has posted the preliminary 2019 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes. For each code, CMS announces whether it intends to use crosswalking or gapfilling to establish the payment rate, along with the agency’s rationale for the decision. CMS will accept public comments on these…
CMS is still rolling out policies and procedures to fully implement the major clinical laboratory payment reforms mandated by the Protecting Access to Medicare Act of 2014 (PAMA). As previously reported, the June 23, 2016 final PAMA rule established the framework for basing Medicare clinical laboratory fee schedule (CLFS) payment on private insurance payment…
On June 25, 2018, CMS is holding its annual public meeting to consider the appropriate basis (crosswalking or gapfilling) for establishing payment amounts for new or substantially revised HCPCS codes being considered for payment under the 2019 Medicare clinical laboratory fee schedule (CLFS). The meeting will also address reconsideration requests regarding final determinations made last…
CMS has issued final 2018 Medicare clinical laboratory fee schedule (CLFS) rates, which are based on private payer data as mandated by the Protecting Access to Medicare Act of 2014 (PAMA). A companion document explains changes the agency made in response to public comments on the September 2017 preliminary rates and clarifying its…
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,…
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 …
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…
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…
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. …
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…
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,…
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 Fee Schedule. OIG compared this data with the same claims data for 2014, and found that, among other things:
Continue Reading New OIG Studies Reveal Clinical Lab Test Payment Trends and CMS’ Progress in Implementing PAMA
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…
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…
