On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA). This legislation creates a single, national fee schedule which is based upon private payor rates. Applicable laboratories performing clinical diagnostic laboratory tests had to report the amounts paid by private insurers for laboratory tests. Medicare then used the weighted median of private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning January 1, 2018.
CMS initially estimated that using a market-based system stipulated under PAMA would save $390 million in the first year of 2018, and $3.93 billion over a decade1. In September 2017, CMS released the proposed new rates and the rate cuts are more significant than originally anticipated. The proposed rate structure would result in reductions of $670 million in Part B program payments for clinical lab fee schedule (CLFS) tests in 20182. The preliminary rate schedule introduces dramatic cuts. 58% of tests will have reductions phased in over multiple years as the preliminary rates exceed the maximum per year reduction3.
This new rate structure represents a dramatic shift in the way laboratory tests are reimbursed. This webinar will provide clinical laboratories with an update on the implementation of the new Clinical Lab Fee Schedule and the financial impact to clinical labs.