Laboratory Question for the Week of February 6, 2017

Laboratory Compliance Question of the Week


Is CMS using mostly hospital data to determine the new CLFS rates?


According to an analysis by the Department of Health & Human Services Office of Inspector General (OIG), in 2015, independent labs accounted for 55 percent of the Medicare Part B payments for lab tests, hospital labs accounted for 24 percent, and physician office labs accounted for the remaining 20 percent.

Therefore, says the OIG’s report, the new payment rates for lab tests will be based primarily on private payer data from independent labs. It also states that new payment rates will be based on data provided by a projected 5 percent of labs—labs that received 69 percent of Medicare payments in 2015.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.