After a flood of protests, CMS abandoned their proposal to cap Professional Fee Schedule (PFS) rates at hospital Outpatient Prospective Payment System (OPPS) rates for any service reimbursed higher in a physician office setting than in a hospital outpatient setting. According to estimates, this would have reduced reimbursement to Independent Laboratories by around 26% and some common anatomic pathology codes would have been cut by as much as 80%. This provides relief for now; however, CMS stated it will consider all comments received and develop a proposal for using outpatient and ambulatory surgical center rates in developing relative value units (RVU). This will be accomplished with a goal of ‘bringing payment for lab services provided in non-facility settings more in line with services provided in facility settings,’ according to CMS. For more information about this and issues affecting your reimbursement, please contact your Practice Manager.
In working through the wide variety of billing arrangements, APS found payments that we had been missing.