Pricing for the CLFS is set to change in the most significant way for laboratories in probably several decades.  Pricing is governed by Section 216 of the Protecting Access to Medicare Act of 2014, also known as PAMA.

The law essentially required CMS to collect data on all of the clinical laboratory transactions for everything from clinical lab to genomics and analyze it.  The data is then used to determine a median pricing and this is what becomes the new laboratory fee schedule.  There is a maximum allowable drop in reimbursement of 10% per year, so the max it can drop each year for the next three years is 10%, although this can be quite large cumulatively.

We have uploaded a copy of the proposed pricing from Medicare here:

2018 CMS Proposed Clinical Laboratory Fee Schedule PAMA

The proposed laboratory fee schedule is open to public comment through October 23, 2017.  CMS will issue its final ruling on the CLFS later this year.

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time, please contact:

Sean McSweeney

Apache Health

smcsweeney at apachemedicalbilling dotcom



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