CMS to calculate new payment rates for lab tests

If your practice has an office laboratory, a new final rule issued by the Centers for Medicare & Medicaid Services (CMS) may affect you.

The rule requires that certain clinical labs report how much they receive from private insurers for lab tests as well as lab test volumes. CMS plans to use this information to calculate new Medicare payment rates under the Clinical Laboratory Fee Schedule (CLFS), beginning in 2018.

Only labs that receive at least $12,500 a year in Medicare revenues from laboratory services paid under the CLFS and more than half of their Medicare revenues from laboratory and/or physician services will have to report.

CMS estimates this will include only 5 percent of physician office labs and about half of independent labs. However, the information provided by those labs will help revise Medicare payment rates for everyone.

Under the plan, the affected labs will collect payer data from the first six months of this year and report it to CMS between Jan. 1 and March 31 of next year. CMS will then calculate the new Medicare rates, based on a weighted median of private payers for each test, and post them in early November 2017. They will go into effect Jan. 1, 2018.

For more information, see the CMS press release and detailed fact sheet.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians