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.
-
AIM Coalition Welcomes Health Affairs Study on Urologist “Self-Referral” of Surgical Pathology Services
Study by Georgetown’s Jean Mitchell says self-referral is increasing billings for prostate biopsy pathology evaluations, but not improving cancer detection Washington DC – The ... Read More -
New Study On Self-Referral Labs: More Tests, Higher Costs, Fewer Cancer Detections
CAP Urges Immediate Action to Close In-office Loophole in Federal Law NORTHFIELD, Ill. — A new study by researchers at Georgetown University reveals that the ... Read More -
ACLA Lauds New Health Affairs Study Finding Medicare Costs Rise and Fewer Cancers Are Detected When Physicians Self-Refer for Prostate Cancer Surgical Pathology Services
Study demonstrates physicians’ financial self-interest may drive unwarranted procedures and unnecessary Medicare spending; highlights the need for Congress to end legal loophole permitting self-referral of ... Read More -
Comments Regarding Appropriate Use of Clinical Laboratory Testing
April 4, 2012 ACLA Comments on Choosing Wisely and Appropriate Use of Clinical Laboratory Testing Statement: The American Clinical Laboratory Association welcomes the Choosing ... Read More -
Letter to HHS on ICD-10 Implementation
March 28, 2012 The Honorable Kathleen Sebelius Secretary Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue, S.W. Washington, ... Read More -
Letter to Speaker Boehner and Majority Leader Reid Regarding Medicare Clinical Laboratory Fee Schedule
March 6, 2012 The Honorable John A. Boehner Speaker U.S. House of Representatives H-232, The Capitol Washington, DC 20515 The Honorable Harry Reid Majority ... Read More -
Big Cuts in Reimbursement for Medicare Lab Tests will Hurt Patients, says ACLA
Cumulative cuts from recently enacted legislation total 23% over next 10 years Washington, DC — Recently enacted budget cuts that would slash Medicare reimbursement ... Read More -
Comments on Coverage with Evidence Development
January 18, 2012 Louis Jacques, MD Director, Coverage and Analysis Group Office of Clinical Standards Quality Centers for Medicare and Medicaid Services 7500 Security ... Read More -
Letter to Chairman Baucus and Ranking Member Hatch Regarding TC “Grandfather” Provision
December 7, 2011 The Honorable Max Baucus Chairman Senate Finance Committee Washington, DC 20510 The Honorable Orrin Hatch Ranking Member Senate ... Read More -
Letter to Majority Leader Reid and Minority Leader McConnell Regarding SGR
December 5, 2011 The Honorable Harry Reid Majority Leader U.S. Senate Washington, D.C. 20510 The Honorable Mitch McConnell Minority Leader U.S. Senate ... Read More