CMS sets start date for the new clinical lab payment system

by: Julia Kyles, CPC Jun 17, 2016

Here's some good news for labs that were dreading the new payment system for clinical diagnostic tests: CMS will delay implementation for one year, according to the final rule. The new fee schedule will kick in Jan. 1, 2018.

The vast majority of labs will be spared the burden of reporting the private payer revenue information Medicare will use to set its fees for lab services. CMS estimates approximately 5% of labs will meet its two-level requirement. During a six-month reporting period the organization must receive:

More than 50% of its Medicare revenues from lab and/or physician services.
At least $12,500 for services paid under the clinical lab fee schedule.

The first new fee schedule will be based on the private payer payments these labs received from Jan. 1 through June 30, but they don't need to submit the information until Jan. 1, 2017. CMS estimates the new fee schedule will save the program $390 million in 2018.

Blog Tags: CMS

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