CMS issues final rule revising Medicare payment system for laboratory tests

The Centers for Medicare & Medicaid Services late today issued a final rule revising the Medicare payment system for clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule and implementing other changes required by section 216 of the Protecting Access to Medicare Act of 2014. CMS will implement the new approach to setting CLFS payment rates on Jan. 1, 2018, a one-year delay from the date the agency originally proposed, as recommended by the AHA. In addition, in response to comments from the AHA and others, CMS in the final rule decided to use the national provider identifier to apply the statutory requirements to determine whether a laboratory is considered an applicable laboratory. CMS had proposed using taxpayer identification numbers as a mechanism for defining an applicable laboratory, which would have meant virtually no hospital-based laboratories and only 4% of physician office laboratories would qualify as applicable laboratories. “We are pleased that CMS will delay the program start date and include data from hospital-based labs in setting payment rates,” said AHA Executive Vice President Tom Nickels. “The one-year delay will give labs more time to develop the technology needed to participate in the program. Including hospital-based labs will better reflect market trends and lead to more appropriate reimbursement.” For more on the final rule, see the CMS factsheet. AHA staff are reviewing the rule, and members will receive more information on the rule.