Laboratory Question for the Week of October 17, 2016

Laboratory Compliance Question of the Week


In the new lab payment system, CMS discusses “applicable” labs and reporting entities. Are these the same thing or different?


In SE1619, the Centers for Medicare & Medicaid Services (CMS) explain the difference between applicable lab and reporting entity. To determine whether your lab is “applicable” to report data, it must be certified under the CLIA and must bill under its national provider identifier (NPI). In the memo, CMS also explains the meaning of the “Medicare revenues threshold” and “low expenditure threshold,” which also figure into whether a lab is applicable. It is the tax identification number (TIN) level entity that actually reports the applicable information individually for all its NPI-level applicable laboratories.

To understand the above and more go to

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.