CMS delays rule requiring clinical labs to submit private payer data: 5 things to know

CMS delayed a rule requiring clinical labs paid under the Medicare Clinical Laboratory Fee Schedule to report private payer data to the agency, extending the submission deadline 60 days. 

CLFS provides payment for about 1,300 clinical diagnostic laboratory tests, and Medicare pays approximately $7 billion per year for these tests, according to CMS.

Here are five things to know about the delay.

1. CMS issued a final rule in June 2016 revising the Medicare payments systems for clinical lab tests paid under CLFS and implementing changes required by the Protecting Access to Medicare Act of 2014. 

2. The rule decreased the amount Medicare pays for clinical labs to make it on par with what private payers reimburse. 

3. The final rule required labs to submit certain private payer data by  March 31, 2017. On March 30, CMS postponed the data submission date to May 30, 2017. CMS said the extension reflects "industry feedback suggest[ing] that many reporting entities will not be able to submit a complete set of applicable information to CMS by the March 31, 2017 deadline."

4. CMS said the 60-day delay is the most time it can give clinical labs while still calculating CLFS payment rates before they go into effect Jan. 1, 2018. 

5. The American Clinical Laboratory Association praised the decision. 
"ACLA supports reforming the Medicare payment system, but it is imperative that modifications work in favor of patient access, and recognize the value and role of diagnostics," said Julie Khani, president of the ACLA. "We look forward to continuing to work with CMS on addressing these issues and achieving a fair and effective solution that reinforces a robust laboratory market and protects patient access to important diagnostics." 

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