CMS issues proposed rule revising Medicare payment system for laboratory tests

The Centers for Medicare & Medicaid Services today issued a proposed rule that would revise the Medicare payment system for clinical diagnostic laboratory tests and implement other changes required by section 216 of the Protecting Access to Medicare Act of 2014. Under the proposed rule, certain “applicable” laboratories would be required to report private payer rate and volume data if they receive at least $50,000 in Medicare revenues from laboratory services and more than 50% of their Medicare revenues from laboratory and physician services. Laboratories would collect private payer data from July 1, 2015 through Dec. 31, 2015 and report it to CMS by March 31, 2016. CMS would post the new Medicare rates by Nov. 1, 2016 for lab tests beginning Jan. 1, 2017. In a factsheet on the rule, CMS said it does not expect hospital laboratories to meet the definition of an “applicable laboratory” subject to the reporting requirements. The proposed rule will be published in the Oct. 1 Federal Register, with comments accepted through Nov. 25. AHA staff are reviewing the rule; members will receive more details.