CMS released its Final Rules for the 2014 Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS)

CMS issued on November 27, 2013 a final rule that updates payment policies and rates under the Medicare Physician Fee Schedule (MPFS) for physicians’ services furnished in calendar year (CY) 2014. The CY 2014 MPFS conversion factor (CF) is $27.2006. The CY 2014 conversion factor includes a statutorily required 20.1 percent SGR-related reduction unless Congress acts to avert the cut.

Revisit and revalue all CLFS tests

• Every year, starting in 2014, CMS will analyze data and come up with a list of tests that should be adjusted.  CMS will then solicit comments on the proposed list of tests. In addition, CMS will allow the public to nominate test codes that should be revalued, although it states “CMS will retain the final authority in determining which test codes move forward through the payment revision process.”

Capping PFS rates at hospital outpatient rates

• CMS, for the time being, is not moving forward with this proposal. CMS proposed that all services on the Physician Fee Schedule be capped for their technical component at the Hospital Outpatient Rate. If implemented, it would have meant a large number of pathology codes (88307, 88309, 88342, etc) would have had their technical components (TC) reimbursed at the much lower hospital outpatient rates. For a large number of tests, this would have meant labs would not have been paid enough to overcome the cost of performing the tests.

Bundle all labs (except molecular tests) to a hospital outpatient visit fee

• Instead of reimbursing hospital outpatient and free-standing ASCs for individual clinical lab and anatomic pathology tests, CMS will simply make a bundled payment (akin to a DRG payment for inpatient care) that includes all of the patient’s care at the surgery center, including pathology. This means labs and pathologists will be forced to “negotiate” with hospitals and ASC’s to receive fair compensation out of the bundled payment. 

Source: https://www.federalregister.gov/articles/2013/12/10/2013-28696/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-clinical-laboratory