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.

Read More

  • Extenders Coalition Letter to Senators Reid and McConnell, Representatives Pelosi and Boehner

    November 01, 2010
    November 1, 2010 The Honorable Harry Reid Majority Leader, United States Senate S-221, United States Capitol Washington, DC 20510 The Honorable Nancy Pelosi Speaker, United States House of Representatives H-232, United States Capitol Washington, DC 20510 The Honorable Mitch McConnell Minority Leader, United States Senate S-231, United States Capitol Washington DC 20510 The Honorable John Boehner Minority Leader, United States House of Representatives H-204Continue Reading »...
  • Comments on Physician Fee Schedule CY 2011

    August 20, 2010
      August 20, 2010 The American Clinical Laboratory Association (ACLA) is pleased to have this opportunity to submit our comments on the Medicare Physician Fee Schedule Proposed Rule for Calendar Year (CY) 2011 (“the Proposed Rule”).’ ACLA is an association representing clinical laboratories throughout the country, including local, regional, and national laboratories. As providers of clinical diagnostic laboratory services to Medicare beneficiaries, ACLA memberContinue Reading »...
1 2 3 4 5 6 7 8 9 10 11 12