Lab Reimbursement Looks for a Lifeline with a New ACLA Campaign

In a decisive move, the American Clinical Laboratory Association (ACLA) is attempting to rally the lab community and stakeholders across the nation while taking on Congress by creating a new campaign called the “Stop Lab Cuts campaign.” The campaign is an effort to safeguard patient access to laboratory services through an advocacy effort to pass the Saving Access to Laboratory Services Act (S. 4449/H.R. 8188) by the end of the year. With proposed policies over the years aiming to strike and weaken reimbursement, staffing levels impacted by the great resignation, and the general financial turmoil created by a global pandemic, the value of protecting dwindling reimbursement is imperative.

A Looming Threat

As you may know, Medicare payment cuts are likely coming at the start of next year. By cutting reimbursement, access to diagnostic tests could be put at risk. However, according to the ACLA, there are even more consequences at stake stating “After three prior rounds of 10 percent cuts, additional reductions to payments may result in a weakened clinical lab infrastructure, making it more difficult to deliver routine health care and respond to the next public health crisis. Without strong clinical laboratories, the nation’s response to COVID-19 would have been severely hampered.”

According to the ACLA, over 800 tests across the nation are slated to experience an up to 15 percent reimbursement cut at the start of the next year. However, this is the shadow of “previous rounds of cuts between 2017 and 2022 that resulted in payment for tests used to screen and diagnose diabetes, heart disease, and other chronic conditions to be cut by 27 percent. Some tests could see a cumulative cut of up to 41 percent.”

Furthermore, reimbursement cuts stifle investment in future generations of diagnostic tests.

The Promise of Potential Legislation

The bipartisan and bicameral legislation plans to adjust the existing 2014 Protecting Access to Medicare Act (PAMA). As many may know the PAMA Act, has resulted in “significant cuts to Medicare payments for routine laboratory tests that guide clinical decision-making.” By building a robust clinical laboratory infrastructure, healthcare will be able to reinforce the execution of everyday patient care. This structure, if properly maintained, can provide protection against the inevitable future public health crisis. The Saving Access to Laboratory Service Act would support existing needs while creating innovation for future generations of clinical diagnostics.

In an online press release, Susan Van Meter, ACLA President, commented that “Without congressional intervention this year, laboratories across the country will face a fourth round of Medicare reimbursement cuts, which could threaten the delivery of routine care, undermine the clinical laboratory infrastructure needed to manage multiple public health challenges, and reduce investment in innovation, Congress has acted three times to delay these harmful reimbursement cuts, but long-term reform is needed to safeguard access to the essential tests that patients need.”

The act was put forward early this summer in June by senators Sherrod Brown (D-OH) and Richard Burr (R-NC), along with Reps. Bill Pascrell (D-NJ), Scott Peters (D-CA), Richard Hudson (R-NC), Gus Bilirakis (R-FL), and Kurt Schrader (D-OR). The act would break down the data reporting and offer a simplified process. Policies within the act guide the Centers for Medicare & Medicaid Services (CMS) to gather data from a statistical sampling of not just a few types of labs but all significant types of labs including hospital, independent, and physician office laboratories.

The ACLA praised the potential policy, stating “Targeted sampling, as designed by the Saving Access to Laboratory Services Act, is a straightforward solution to collecting representative private market data to achieve accurate and sustainable Medicare rates for laboratory services. In the long-term, sustainability for lab reimbursement will support strong clinical laboratory infrastructure to protect public health and innovation in tomorrow’s diagnostics while providing robust access to improve patient health.”

To explore more coding and compliance topics subscribe to our Laboratory Compliance Manager Newsletter. The Laboratory Compliance Manager Newsletter is your monthly gateway to the latest laboratory-specific compliance, coding, and reimbursement news including topics like the clinical laboratory fee schedule, coding changes, the final rules, CLIA-waived tests, PLA code releases, and more. Subscribe today!

Information Source:
https://stoplabcuts.org/

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Bryan Nordley

Bryan Nordley is a seasoned professional writer, strategist, and researcher with over a decade’s worth of combined experience. Bryan launched his professional health writing career at the University of British Columbia’s Faculty of Medicine, one of the top 30 faculty of medicine programs in the world, working under the School of Public Health as a communications assistant. From there, he expanded his expertise and knowledge into private healthcare and podiatry before taking the role of healthcare writer at MedLearn Media. Bryan is the lead writer for the MedLearn Publishing brand previously producing both the acclaimed radiology and laboratory compliance manager newsletter products, while currently writing the compliance questions of the week which reach over 10,000 subscribers, creating the MedLearn Publishing Insights blogs and collaborating with operations and nationally renowned subject matter experts, in addition to serving as an editor for a variety of MedLearn publications along with marketing initiatives. Bryan continues to keep his pulse on the latest healthcare industry news, analyzing and reporting with strategic insight.

Related Stories

How to Report New Code Category W44

How to Report New Code Category W44

One of the goals of medical coding is documenting encounter notes to the highest degree of specificity. ICD-10-CM had some existing codes for documenting foreign

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →