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.
-
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 for clinical laboratory tests by 23% over the next 10 years threaten the ability of clinical labs to serve Medicare patients, according to a letter that the American Clinical Laboratory Association sent today to House Speaker John Boehner andContinue Reading »... -
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 Blvd Baltimore, Maryland 21244 RE: Coverage with Evidence Development (CED) Public Comment & Solicitation Dear Dr. Jacques, The American Clinical Laboratory Association (“ACLA”) is pleased to have this opportunity to submit comments to the Centers for Medicare and MedicaidContinue Reading »... -
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 Finance Committee Washington, DC 20510 Dear Chairman Baucus and Ranking Member Hatch: The undersigned organizations, representing laboratories, hospitals, laboratory professionals, physicians, and the patients we serve, urge you to extend an expiring provision that would ensure hospitalsContinue Reading »... -
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 Washington, D.C. 20510 Dear Majority Leader Reid and Minority Leader McConnell: The Alliance for Integrity in Medicare (AIM), a coalition committed to ending the practice of inappropri- ate physician self-referral in Medicare, appreciates your commitment to addressContinue Reading »... -
Letter to Chairman Upton and Ranking Member Waxman Regarding SGR
December 5, 2011 The Honorable Fred Upton Chairman Committee on Energy and Commerce U.S. House of Representatives Washington, D.C. 20515 The Honorable Henry Waxman Ranking Member Committee on Energy and Commerce U.S. House of Representatives Washington, D.C. 20515 Dear Chairman Upton and Ranking Member Waxman: The Alliance for Integrity in Medicare (AIM), a coalition committed to ending theContinue Reading »... -
Letter to Chairman Baucus and Ranking Member Hatch Regarding SGR
See the original PDF here. December 5, 2011 The Honorable Max Baucus Chairman, Committee on Finance U.S. Senate Washington, D.C. 20510 The Honorable Orrin Hatch Ranking Member, Committee on Finance U.S. Senate Washington, D.C. 20510 Dear Chairman Baucus and Ranking Member Hatch: The Alliance for Integrity in Medicare (AIM), a coalition committed to ending the practice of inappropri- ate physicianContinue Reading »... -
Letter to Chairman Camp and Ranking Member Levin Regarding SGR
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 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
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 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 »...
