CMS will determine the CLFS
payment to equal the weighted median prices of private payer rates, and these weighted medians will be the Medicare rates that are effective beginning on January 1,2017.
Section 216 requires applicable laboratories to submit data every three years on the price paid by each private payer, and the volume of tests paid for by each payer, for each test on the CLFS
offered by the lab.
Discuss two reasons for the actual decreases in reimbursement for laboratories since the CLFS
Section 216 requires that CMS issue a final rule by June 30, 2015, establishing the data collection parameters for the CLFS
Outreach labs serve non-patients, and since tests provided to non-patients are still paid separately under the CLFS
, now outreach labs and hospital labs will receive different reimbursement rates for the same tests.
But of even greater importance to the laboratory community, Section 216 of PAMA provides a new, market-based method for updating individual test fees on the CLFS
Since the CLFS
was implemented in 1984, all but which of the following actions by Congress did NOT have an impact on the level of laboratory reimbursement.
The new law requires clinical laboratories that receive a majority of their Medicare revenues from either the Clinical Laboratory Fee Schedule (CLFS
) or the Physician Fee Schedule (PFS) to report to the Centers for Medicare and Medicaid Services (CMS) all of their non-capitated private payer rates and the volume for every laboratory test currently on the CLFS
, beginning in 2016.
The CMS initiative also ignored the fact that the current fee schedule already reflects numerous CPI freezes, downward adjustments of the National Limitation Amounts (NLAs), and statutory reductions imposed across-the-board to the CLFS
In 2017, market-based rates under the Protecting Access to Medicare Act (PAMA) are expected to replace the current Medicare CLFS
The overhaul of the CLFS
will reduce some of the uncertainty that existed before PAMA with respect to reimbursement pricing, especially over the next two to three years.
In the final rule, CMS said it would review each of the more than 1,200 codes on the CLFS
over the next five years, and adjust payments for each test as warranted by "technological changes" that have occurred since the fee was originally set.