Hospital OPPS Payment System Changes for 2018-Revisions to the Laboratory Date of Service Policy

CMS is increasing the OPPS payment rates by 1.35 percent for 2018. CMS estimates an overall impact of 1.4 percent payment increase for providers paid under the OPPS in CY 2018. CMS has made revisions to the Laboratory Date of Service Policy. For a clinical diagnostic laboratory test, the date of service (DOS) is typically the date the specimen was collected, unless certain conditions are met. CMS considered potential modifications to the DOS policy that would allow laboratories to bill Medicare directly for molecular pathology tests and certain ADLTs which are excluded from the OPPS packaging policy and ordered less than 14 days following the date of the patient’s discharge from the hospital. After considering the public comments received, CMS added an additional exception to the current laboratory DOS regulations, effective January 1, 2018. This new exception to the laboratory DOS policy generally permits laboratories to bill Medicare directly for ADLTs and molecular pathology tests excluded from OPPS packaging policy if the specimen was collected from a hospital outpatient during a hospital outpatient encounter and the test was performed following the patient’s discharge from the hospital outpatient department.

Source: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-01.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending