CLFS revision to lead to 20% decrease in outpatient lab payments in 2018

Why This Topic Matters

The article matters because it summarizes a major Medicare laboratory payment update that can affect reimbursement, budgeting, and contracting across multiple provider settings. It helps readers understand the scope of the change, the CMS data foundation behind it, and the broader downstream impact on non-Medicare and contract-based payment arrangements.

Article Sections

1. Overview of the CLFS revision

   Introduces the Medicare laboratory payment update, the policy basis for the change, and the expected timing of implementation.

2. Rate-setting process and phase-in timeline

   Describes the CMS data collection and rate-setting approach used to build the updated fee schedule and summarizes the phased implementation period.

3. Application of new CLFS rates across provider settings

   Explains which outpatient and institutional payment settings are affected by the revised laboratory fee schedule and how the updated rates are applied broadly.

4. Data used to develop the new rates

   Summarizes the scope and sources of the laboratory payment data CMS used to establish the revised schedule.

5. Analysis of new payment rates

   Reviews CMS’s overall findings on how the new rates compare with prior amounts and how the impact varies across the code set.

6. Strategic considerations

   Discusses broader operational and contracting implications for providers, suppliers, and other payers connected to the Medicare laboratory fee schedule.

7. Summary

   Concludes with a high-level assessment of preparedness and the need for financial and operational planning.