White Paper

Is Medicare Zero for Three? Diagnostics Policy Proposals for CY2014

September 13, 2013

Introduction

Each July, the Medicare agency makes policy proposals for changes in reimbursement for services delivered by physicians, hospital outpatient centers, and independent laboratories. For CY2014, CMS proposed three major policy changes impacting laboratory services. CMS proposed to revisit all prices on the Clinical Laboratory Fee Schedule, to determine whether technology changes over 5 to 30 years (depending on the code) should trigger administrative repricing, and by how much. CMS proposed to cap prices paid to independent labs for physician molecular pathology procedures – those priced in RVUs – based on a crosswalk to payment rates for hospital outpatient services. Finally, CMS proposed to bundle all diagnostic tests, including laboratory tests, to visits or procedures where the test was used or ordered by a physician. Each of the three proposals represents a major change in policy, and the implementation of each of them raises substantial problems.

Download the full content of Is Medicare Zero for Three? Diagnostics Policy Proposals for CY2014 (.pdf)