Laboratory Payments Adjusted for Technological Changes? Forget That

The Centers for Medicare and Medicaid Services (CMS) proposes to rescind the statutory authority in the Social Security Act that allows adjustments to the lab fee schedule based on technological changes. Instead, CMS will add a new Section 1834A of the act requiring a new process for clinical laboratory payments based on private payer rates. These changes and others that will affect clinical lab payments were contained in a proposed rule titled “Revisions to Payment Policies Under the Physician Fee Schedule for CY 2015.” This is the “official” rule that rescinds the technological changes proposal from 2014. After raising an uproar in the lab industry with its proposal to make adjustments to the fee schedule based on technological changes last year, CMS now must change course and develop another process required as part of the Protecting Access to Medicare Act (PAMA). PAMA provided some details on the new process and laboratory administrators and compliance officers await the details that CMS has promised to provide later this year or early next year. New compliance risks accompany the new process, and laboratory compliance officers must make certain they stay abreast of these changes so they can provide appropriate guidance to laboratory leadership during these changes. Takeaway: The regulatory and legislative landscape is constantly changing, requiring compliance officers to assess each new rule to determine not only its risks but, in light of the reversals described above, when to take action on a proposed change.