Cap of Lab Payments Avoided

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.