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Clinical Lab Reimbursement Overhaul: How to Prepare for It

4 August 2016

If you’re a provider of clinical laboratory tests, the recent overhaul of Medicare reimbursement for such tests could impose new significant compliance obligations on your organization.

As part of the overhaul, the Medicare rate for clinical laboratory tests under the Clinical Laboratory Fee Schedule will be based on private payer rates beginning on January 2018. Providers must collect payment data from January through June 2016 and report them to CMS between January and March 2017. Providers who fail to meet the reporting obligations may face civil monetary penalties.

Here are those key dates:

  • January 2018: Medicare rate will be based on private payer rates
  • January through June 2016: Providers collect data
  • January – March 2017: Providers report data to CMS

There’s a lot of work to be done between now and the end of the year. For starters, providers will need to develop and implement systems for collecting and reporting each rate they were paid by private payers for each test they perform during the reporting period. The President, CEO, or CFO (or designee) of the lab must sign a certification that the data submitted are accurate, complete and truthful. They will also need to determine whether they perform tests that qualify under a new category defined by CMS as “Advanced Diagnostic Lab Tests” that are subject to different reporting and payment requirements.

This engaging webinar will bring together attorneys with a wealth of experience in providing clients with practical solutions for often complex issues involving clinical lab reimbursement and government price reporting. We will walk you through:

  • Which labs are required to report their payment rates and which are excluded
  • What payment data must be reported and how
  • When is payment data collected and reported
  • What will CMS do with the data it receives
  • Which tests are considered “Advanced Diagnostic Lab Tests” and what does that mean
  • How will rates be determined for new lab tests
  • How will CMS’s new rules affect clinical lab fee schedule rates for existing tests
  • What will happen if labs fail to report their payment data, or report inaccurate data
  • What lessons we’ve learned from our significant experience with analogous drug price reporting requirements, and how those lessons may help labs better comply with their new rate reporting obligations

We hope you’ll join us.

4 August 2016

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