Applicable laboratories must collect and report private payer rates and test volumes for clinical diagnostic laboratory services by Mar. 31, 2017. Pursuant to the Protecting Access to Medicare Act (PAMA) of 2014, CMS is required to use this information to determine new payment rates under the Clinical Laboratory Fee Schedule (CLFS) using the weighted median price for tests. The new payment structure was set to start in 2017; however at the urging of MGMA and other stakeholders, CMS delayed implementation of the new rates until Jan. 1, 2018.
The definition of an “applicable” lab is intended to be narrow, and CMS estimates that 95% of physician office labs and 55% of independent labs will be excluded from reporting requirements. The agency released a user guide to assist applicable labs in reporting and certifying applicable information. The guidance explains how to request access to the CLFS data collection system and upload and certify data. MGMA members are encouraged no to wait until the deadline to begin reporting.