AMT Joins Lab Organizations in Delaying Medicare Clinical Laboratory Fee Schedule (CLFS) 3/21/17

03/22/17

AMT Joins Lab Organizations in Delaying CLFS

AMT has joined other lab community stakeholders in urging the Centers for Medicare and Medicaid Services (CMS) to delay for another year – until January 1, 2019 – massive changes to the Medicare Clinical Laboratory Fee Schedule (CLFS). The Protecting Access to Medicare Act of 2014 (PAMA) directed CMS to revise the CLFS based on market prices paid for lab testing by private payers. Unfortunately, CMS’s implementation of PAMA has a number of serious deficiencies that will result in artificially depressed pricing for the most commonly ordered diagnostic tests. Among the problems with CMS’s current scheme:

  • Only about 5% of all labs are allowed to report price data. This means that almost no hospital labs or physician-office labs, which are typically paid more than large reference labs, will figure in the pricing formula.
  • As recently as March 2017 – just weeks before the end of the first reporting period – CMS was issuing conflicting advice on its definition of “applicable laboratory” – i.e., which labs are required to submit price data.
  • Questions abound concerning the accuracy of pricing data reported to CMS. Reports from claims processing consultants indicated that private payers frequently make errors in the amounts paid to labs for test services, which in turn results in labs’ reporting faulty data to CMS.

AMT and numerous other lab organizations signed a coalition letter to HHS Secretary Tom Price March 23rd urging the agency to take the following steps:

  • Delay enforcement of the updated CLFS until January 1, 2019
  • Reassess and revise the definition of “applicable laboratory” to appropriately capture the true laboratory market, so that true market-based reimbursement rates can be calculated.

A record number of AMT members also participated in the clinical lab community’s Legislative Symposium and Legislative Day in Washington March 20-21. Thirteen AMT members visited congressional offices on “Leg Day” encouraging their Representatives and Senators to support the lab community’s efforts to delay PAMA so that the law can be properly implemented without causing drastic harm to hospital, POL, and community labs and resultant loss of patient access to critical diagnostic services.

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