Reimbursement and Coverage

Clinical laboratories are reimbursed for providing services to Medicare beneficiaries using either the Physician Fee Schedule (PFS) or the Clinical Laboratory Fee Schedule (CLFS), depending on the nature of the service.  In addition, clinical laboratories provide services to beneficiaries of other government programs such as Medicaid, TRICARE and the Federal Employee Health Benefit Plan (FEHBP),…

Clinical laboratories are reimbursed for providing services to Medicare beneficiaries using either the Physician Fee Schedule (PFS) or the Clinical Laboratory Fee Schedule (CLFS), depending on the nature of the service.  In addition, clinical laboratories provide services to beneficiaries of other government programs such as Medicaid, TRICARE and the Federal Employee Health Benefit Plan (FEHBP), as well as commercial plans.

Lab reimbursement in many of these programs has been reduced in recent years, and in the case of the Medicare program, annual cuts are scheduled in current law not only as a result of sequestration, but also through annual cuts built into the Affordable Care Act.

While payments for lab services are being slashed, the costs associated with providing critical laboratory services - including labor, supplies, and transportation - continue to climb.

Although many labs have managed to navigate changes in markets and reimbursement and while still continually improving quality, continued arbitrary and severe payment reductions will result in reduced access to essential tests for critically ill patients, less innovation, more closures or consolidation of businesses, and more people out of jobs.

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  • Letter to Chairman Camp and Ranking Member Levin Regarding SGR

    December 03, 2011
        December 5, 2011   The Honorable Dave Camp Chairman Committee on Ways and Means U.S. House of Representatives Washington, D.C. 20515   The Honorable Sander Levin Ranking Member Committee on Ways and Means U.S. House of Representatives Washington, D.C. 20515   Dear Chairman Camp and Ranking Member Levin:   The Alliance for Integrity in Medicare (AIM), a coalition committed to ending theContinue Reading »...
  • AIM Letter to Sens Murray and Hensarling Regarding IOAS Letter

    September 20, 2011
        September 20, 2011   The Honorable Patty Murray, Co-Chair, Joint Select Committee on Deficit Reduction   The Honorable Jeb Hensarling, Co-Chair, Joint Select Committee on Deficit Reduction   Dear Chairwoman Murray and Chairman Hensarling:   On behalf of the Alliance for Integrity in Medicare (AIM), a coalition committed to ending the practice of inappropriate physician self-referral in Medicare, we recognize the challengesContinue Reading »...
  • ACLA Voices Strong Concern Over MedPAC Proposal to Cut Medicare Reimbursement for Laboratory Services

    September 16, 2011
    For Immediate Release September 16, 2011 Contact: Alan Mertz, 202-637-9466 or amertz@acla.com ACLA Voices Strong Concern Over MedPAC Proposal to Cut Medicare Reimbursement for Laboratory Services We believe that additional reimbursement cuts to clinical laboratories are unsustainable, as they would hit an industry that has nothing left to cut.” Washington DC—The proposal now under consideration by the Medicare Payment Advisory Committee to slash MedicareContinue Reading »...
  • Comments Regarding the 2012 PFS Proposed Rule

    August 30, 2011
    August 30, 2011 COMMENTS OF THE AMERICAN CLINICAL LABORATORY ASSOCIATION ON THE MEDICARE PROGRAM; PAYMENT POLICIES UNDER THE PHYSICIAN FEE SCHEDULE AND OTHER REVISIONS TO PART B FOR CY 2012 PROPOSED RULE (CMS-1524-P) The American Clinical Laboratory Association (ACLA) is pleased to have this opportunity to submit our comments on the Medicare Program; Payment Policies under the Physician Fee Schedule and Other Revisions to Part BContinue Reading »...
  • Memorandum in Opposition to New York AB 3551/SB 4660

    June 01, 2011
    MEMORANDUM IN OPPOSITION AB3551/SB4660 (In relation to referrals of patients for health or health related items or services) The American Clinical Laboratory Association (ACLA) opposes AB 3551/SB 4660. ACLA is an association representing clinical laboratories throughout the country, including local, regional and national laboratories, virtually all of which are licensed by New York to provide services to New York residents and several of whichContinue Reading »...
  • Letter to Lawmakers Regarding Physician Payment Reform

    May 11, 2011
    The Honorable Dave Camp Chairman,House Committee on Ways & Means The Honorable Wally Herger Chairman, Subcommittee on Health House Committee on Ways & Means The Honorable Sander Levin Ranking Member, House Committee on Ways & Means The Honorable Pete Stark Ranking Member, Subcommittee on Health House Committee on Ways & Means   Dear Chairmen and Ranking Members: On behalf of the Alliance for IntegrityContinue Reading »...
  • Letter from the US Senate to CMS Regarding the 2011 Medicare Physician Fee Schedule Final Rule

    February 11, 2011
    Donald Berwick, MD Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244—8013 Dear Dr. Berwick: We write you today regarding the Centers for Medicare and Medicaid  Services (CMS) requirement included in the 2011 Medicare Physician Fee Schedule Final Rule that laboratory requisition  fonns be signed by the ordering physician.   We ask that CMS consider delaying enforcement of the requirement, possiblyContinue Reading »...
  • Letter from House of Representatives to CMS Regarding 2011 Medicare Physician Fee Schedule Final Rule

    February 10, 2011
    Donald Berwick, MD Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore,  MD  21244—8013 Dear Dr. Berwick: We write you today regarding the Centers for Medicare and Medicaid Services (CMS) requirement included in the 2011 Medicare Physician Fee Schedule Final Rule that laboratory requisition forms be signed by the ordering physician. We ask that CMS consider delaying enforcement ofContinue Reading »...
  • CLC Letter to CMS Regarding 2011 Medicare PFS

    December 03, 2010
      December 3, 2010 Ms. Marilyn Tavenner Deputy Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201 Dear Ms. Tavenner: The undersigned laboratory, hospital, and health care organizations write to express our opposition to the January 1, 2011 implementation date for the provision in the 2011 Medicare Physician Fee Schedule Final RuleContinue Reading »...
  • ACLA Urges Immediate Action by Congress to Extend Technical Component “Grandfather”

    December 01, 2010
    Washington DC – The American Clinical Laboratory Association (ACLA) today joined nine other health care organizations in sending a letter to the House Ways & Means and Senate Finance Committees’ leadership urging swift action to extend the Technical Component (TC) “Grandfather” set to expire this year on December 31st. The TC “Grandfather” would ensure that hospitals can continue to rely on independent laboratories toContinue Reading »...
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