The Centers for Medicare and Medicaid Services (CMS) has proposed a rule to implement the means to determine the rates paid for lab tests (see IBO 4/15/14). The CMS would require “applicable” labs—those with Clinical Laboratory Improvement Amendments certificates receiving more than half of their Medicare revenue from the clinical laboratory fee schedule (CLFS) or physician fee schedule—to submit reports by next March 31 on private payor rates and volume of lab tests performed between July 1 and December 31 of this year. This considers the facilities’ total revenue. Small entities for which total CLFS revenues fall below $50,000 annually (or $25,000 for the initial six-month reporting period) will be excluded. Thereafter, the reporting of data from the previous calendar year will be required every three years, with the exception of advanced laboratory-developed tests, for which annual reports will be required. Comments on the proposed rule will be accepted through November 24.

Source: Lexology