Question:
Is CMS using mostly hospital data to determine the new CLFS rates?
Answer:
According to an analysis by the Department of Health & Human Services Office of Inspector General (OIG), in 2015, independent labs accounted for 55 percent of the Medicare Part B payments for lab tests, hospital labs accounted for 24 percent, and physician office labs accounted for the remaining 20 percent.
Therefore, says the OIG’s report, the new payment rates for lab tests will be based primarily on private payer data from independent labs. It also states that new payment rates will be based on data provided by a projected 5 percent of labs—labs that received 69 percent of Medicare payments in 2015.