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New Resources on Clinical Lab Fee Schedule Reporting

The Centers for Medicare & Medicaid Services (CMS) released an article and set of frequently asked questions (FAQs) on a new requirement that some hospitals billing Medicare for clinical laboratory services report the rates they receive from private payers for these services to CMS.

The new requirement, included in the calendar year 2019 physician fee schedule final rule, applies to certain hospitals using the clinical laboratory fee schedule to bill Medicare for services from Jan. 1, 2019, through June 30, 2020. CMS will require such hospitals to collect data on private payer prices and the volume of laboratory services paid at that price for the same period of time. Hospitals must report that data to CMS from Jan. 1, 2020, to March 31, 2020.

The new resources provide clarity on:

  • which hospitals and laboratories will be required to submit data;
  • what payer data will be required;
  • when and how to submit data; and
  • data reporting options.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Rachel Schwartz is a policy associate at America's Essential Hospitals.