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CLFS Payment Rate Calculations Now Underway

On March 31, it was announced that the Centers for Medicare and Medicaid Services had issued a formal decision to provide a 60-day discretionary period for the hospitals and medical facilities responsible for data reporting under the Medicare Clinical Laboratory Fee Schedule (CLFS), as well as for those responsible for application submittal under the Medicare Clinical Civil Monetary Penalties (CMPs).

All of this relates to the 2016 decision of Medicare Clinical Diagnostic Laboratory Test Payment System Rules (81 FR 41036).  Many hospitals and facilities were petitioning CMS as they realized that they would not have a completed report to be sent by the March 31 deadline.  Many faced issues upon collecting the data and information requested by CMS.  Those issues had to be corrected before the corrected and completed reports could be sent off to the CMS.  However, the organization has already warned that this extension will be the only one of its kind, so all medical organizations had to work fast to ensure that they were able to get all data submitted before the May 31st end of the discretionary period.  The 60-day period of enforcement discretion is all that could be afforded by CMS, given that they must sift through the reports received and calculate the new CLFS payment rates before January 1.

With that discretionary period at an end, there are many fearing the news regarding the new CLFS payments, which shall be announced prior to the start of the New Year.  There is information to be garnered from the CLFS website, though, which may ease concerns.  These rates will, of course, be based on the weighted median private payor rates.  CMS does plan to announce the new rates by the end of November of this year.

These CMS data collection processes are very important and can have a direct impact on the financial bottom line for all hospitals and medical facilities.  For that reason, it is essential that the information be reported in the correct manner.  There are professionals for hire, who can assist in the collection and reporting of such information to the Centers for Medicare and Medicaid Services.

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