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.