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Ignoring 2016 CMS Laboratory Reporting Requirements Could Get Expensive

November 21, 2016

Hartford, CT – PractiSource, LLC

Ignoring 2016 CMS Laboratory Reporting Requirements Could Get Expensive
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced that it will be requiring most clinical laboratories to submit the first six months of 2016 payment data to CMS in the first quarter of 2017. CMS is doing so to determine Medicare payment rates (in the Clinical Laboratory Fee Schedule) moving forward. These rates will be somewhat based upon a “weighted median” of private payer rates.

According to CMS, “Applicable laboratories must collect applicable information (that is, private payer rates and associated volume for covered tests identified by HCPCS codes) for the period beginning January 1, 2016 through June 30, 2016. Applicable laboratories must report their data to CMS beginning January 1, 2017 through March 31, 2017. CMS will use this data to calculate payment rates for the calendar year 2018 CLFS update.”

The data must be sent by laboratories to Medicare in a very specific manner and file format. Although simple, for many labs this may require report programming by laboratory billing system vendors or RCM companies.

PractiSource strongly suggests that labs comply with the requirements in a timely manner as failure to do so may result in some very stiff fines. Failure to report the requested data to CMS within the deadline can result in fines up to $10,000.00 per day.

If your clinical laboratory has been a client of PractiSource since 1/1/2016 or earlier, you are completely covered. PractiSource has programmed the appropriate reports and will provide your lab with the data needed to forward to CMS. If you are a client which started with PractiSource July 1, 2016 or after, you will need to retrieve this data from the system or RCM vendor responsible for your revenue cycle management during the first six months of 2016. Of course, if a laboratory started with PractiSource during the January through June time period, data will be provided for those dates of service billed by PractiSource.

For more information on the detailed CMS laboratory reporting requirements, history, rules, or to understand if these requirements are applicable to your laboratory, please visit

If you are a PractiSource client and have any concerns, please contact our offices at 860-840-2244 for complete support.

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