News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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American Clinical Laboratory Association’s Annual Meeting Takes Place in Washington, DC, as Congress Considers First Obamacare Repeal-and-Replace Bill

CMS Director speaks at ACLA meeting; acknowledges that labs are alerting the agency to problems with Protecting Access to Medicare Act (PAMA) private payer market reporting, but did not say whether a delay in implementing either reporting or lab test fee cuts would be possible

WASHINGTON, DC—Last week, it was symbolic that, as members of the American Clinical Laboratory Association (ACLA) assembled for their annual meeting, members of the House of Representatives were preparing to vote on the first of several bills intended to “repeal and replace” the Affordable Care Act.

The symbolism comes from the fact that the nation’s medical laboratories and the United States Congress find themselves at major crossroad. For medical laboratories, the issue is the substantial cuts to Medicare Part B clinical laboratory test fees that are scheduled to take effect on January 1, 2018. Predicted by the federal Centers for Medicare and Medicaid Services (CMS) to be a total cut of $400 million in 2018 alone, many expect these Medicare fee cuts to be the single most financially-disruptive event to hit the medical laboratory profession in 25 years.

There’s a similar make-or-break issue unfolding in Congress. Republicans in the House and Senate are caught up in battles to design and pass a series of bills intended to “repeal and replace” the ACA. At their respective crossroads, it remains unclear which path forward each group will follow. (more…)

Clinical Pathology Laboratories Still Waiting for Molecular Test Payments, Speakers Report at First Day of Executive War College

For more than a year Medicare contractors have been developing payment rates for the 114 molecular tests and without setting rates, they cannot make payments.

New Orleans, Louisiana, April 30, 2013—Getting paid for molecular test claims submitted under the new molecular CPT codes was a subject of high interest on the opening day of the Executive War College. Most clinical laboratories and pathology groups performing molecular tests nationwide report that they have not been paid for invoices submitted to Medicare contractors since January 1, 2013.

Several sessions were devoted to this important topic. Medicare contractors nationwide have not paid many of the molecular diagnostic test claims submitted since January 1 according to speakers and attendees at the first day of The Dark Report’s 18th Annual Executive War College in New Orleans. (more…)

In Fixing Physician Medicare Pay, Congress Enacts Yet Another Cut in Clinical Laboratory Test Fee Schedule

A part of this legislation, the grandfather clause on Technical Component (TC) anatomic pathology services was extended through June 1, 2012.

Last Friday, clinical laboratories got bad news about new cuts to the Medicare Part B medical laboratory test fee schedule. Congress voted on a temporary funding fix to keep Medicare physician fees at current levels for 10 more months and a reduction in lab test fees was one source of the money that Congress used to fund this bill.

Pathologists and clinical laboratory managers will be disappointed to learn that the Medicare Clinical Laboratory Fee Schedule (CLFS) was cut by 2% when Congress voted on Friday, February 17, to approve a deal to extend the payroll tax cut for nine months. President Obama could sign the bill into law today (Monday, February 20). The cuts to lab test fees are estimated to total $2.7 billion over 10 years.


Why Congress Is Considering Deep Cuts to Medical Laboratory Test Fees

Nation’s clinical laboratories may see significant reductions in federal funding for medical laboratory tests in the 2012 federal budget

Unprecedented cuts in funding for clinical laboratory services are expected from Congress in coming months. That’s because federal legislators need deep cuts from many sources to cope with the current budget crisis. It is also why some Beltway insiders predict that fees for medical laboratory testing will be substantially reduced.

Although many lab industry associations have alerted their members to certain of these proposals—such as the proposed plan to reinstitute the patient co-pay/co-insurance requirement for Medicare Part B Medical Laboratory Tests—few clinical laboratory managers and pathologists know that there are at least three separate proposals to reduce funding for medical laboratory tests. Each proposal has a chance to make it through the legislative pipeline and become part of the final 2012 federal budget.

It’s Back on the Table! Medicare Patient Co-Pay for Clinical Laboratory Tests Is One of 27 Cost-Cutting Proposals in Federal Debt Ceiling Negotiations

Document leak earlier this week pulls curtain back on potential cuts to Medicare/Medicaid spending

Spending cuts of between $334 billion and $353 billion over the next 10 years are on the table in the negotiations over the federal debt ceiling. The bad news for the clinical laboratory industry is that restoration of the Medicare patient co-pay for medical laboratory tests is not only on the list of proposed spending cuts, but represents a significant chunk of money—as much as $16 billion during the next decade!

Typical of beltway politics, it was only because of a leak that the list of proposed Medicare and Medicaid spending cuts became public knowledge. On Tuesday this week, Kaiser Health News was one of the first to report the leak of the documents. It also posted a copy of the briefing documents on its website.