ACLA Statement on GAO Analysis & Medicare Lab Payments

Latest report reflects misleading, inaccurate assumptions on Medicare lab billing & payment

 Washington, D.C. – Following the recent release of the Government Accountability Office’s (GAO) report on billing and reimbursement for clinical lab tests under the Medicare program, Julie Khani, President of the American Clinical Laboratory Association (ACLA), issued the following statement:

“GAO’s conclusions on overbilling of laboratory services in the Medicare program are fundamentally flawed and inaccurate. The underlying assumptions for GAO’s analysis and recommendations reflect a serious misunderstanding of standard industry practice for laboratory reimbursement and ignore unprecedented cuts to lab tests that pose serious harm to beneficiaries.”

“Clinical laboratories are required to bill Medicare according to the American Medical Association (AMA) CPT guidelines, which provide clear direction on how to report certain tests and disease panels. Rather than acknowledging these current standards, GAO concocts a hypothetical scenario that suggests labs are unbundling these tests and receiving higher reimbursement. This is grossly inaccurate. According to a recent survey of more than 20 million lab claims, labs consistently billed panel tests as required.”

“For the last two years, clinical laboratories have sustained year-over-year multi-million dollar cuts as a result of a haphazard data collection process from the Centers for Medicare and Medicaid Services (CMS). It’s time for the Administration and Congress to address these persistent and glaring PAMA data issues that continue to threaten access to the lifesaving tests and diagnostics for seniors.”

For more information on the impact of PAMA on seniors’ access to lab tests, click here.

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