CMS Proposed Rule for 2014 Physician Fee Schedule released; bad news for laboratories

CMS released its proposed rule for the 2014 Physician Fee Schedule (PFS) and the Clinical Laboratory Fee Schedule (CLFS).  The CLFS changes can be found on pages 253-261 and the news is not good for clinical laboratories. Some of the biggest cuts are aimed at independent testing laboratories, which because of proposed new way of calculating clinical laboratory fee stand to see 26% slashed. For individual practices, specialists in pathology would absorb the biggest average cut of 5%. The 2014 Medicare Physician Fee Schedule (PFS) Proposed Rule includes a proposal to review and revise the amounts paid for all tests currently on the Clinical Laboratory Fee Schedule (CLFS) starting with calendar year 2015. CMS believes that the cost of performing many commonly ordered tests has decreased significantly since they were originally priced over 30 years ago and wants to adjust payment amounts based on changes in technology. CMS is proposing a process to “systematically reexamine the payment amounts established under the CLFS to determine if changes in technology for the delivery of that service warrant an adjustment to the payment amount.” Beginning with the 2015 CLFS, CMS will identify the test codes for which adjustments should be made, discuss how they have been impacted by technological changes, and propose an adjustment to the payment for the test codes. Such adjustments may be either up or down, but CMS clearly expects that most payment amounts will decrease. CMS proposes to review all codes currently on the CLFS, starting with codes that have been on the CLFS the longest, and then work their way forward until all codes are reviewed. This process is expected to take approximately 5 years with initial changes effective January 1, 2015. CMS is seeking comments on all of the proposed changes. The comment period is for 60 days after the publication of the proposed rule in the Federal Register, ending approximately September 20, 2013.

Source: https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-16547.pdf