CMS Proposes Overhaul of Clinical Lab Payment Methodology: What You Need To Know


On Friday, the Centers for Medicare & Medicaid Services (“CMS”) issued a long-awaited proposed rule that would drastically change the payment rates for clinical laboratory services beginning January 1, 2017 (the “Proposed Rule”). As mandated by Congress under the Protecting Access to Medicare Act of 2014 (“PAMA”), the Proposed Rule would require “applicable laboratories” to report payment rates received from private insurers and would base the new Medicare payment amounts on a weighted median of those rates. CMS expects this to result in a $360 million pay cut for laboratories in 2017 alone and potential savings for Medicare of over $2.94 billion over the next five years.

The rule will be formally published in the Federal Register on October 1; until then, it is accessible in display copy here. Comments are due by November 24, 2015.

Please see full Publication below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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