Medicare’s Market-Based Payment Startup: Strategic Options & Compliance Red Flags for Labs

TELECONFERENCE – Medicare’s Market-Based Payment Startup: Strategic Options & Compliance – Red Flags for Labs


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Learn how the future structure of the lab market will be fundamentally altered by Medicare’s new market-based payment system which will directly impact virtually every payer category with profound consequences for all laboratories.  
Medicare’s new market-based pricing system has hurt the “bottom-line” of most clinical laboratories nationwide, from the largest publicly traded labs to the vast majority of hospital based, physician office and independent labs. Importantly, the way Medicare has decided to pay for panels containing automated chemistry tests may help labs offset the deep cuts. However, the loophole may also tempt some labs to develop custom panels to obtain higher reimbursement, and that could raise some serious compliance issues. Meanwhile, ACLA’s federal lawsuit is challenging the process by which CMS calculated new payment rates for lab tests paid through Medicare’s Clinical Laboratory Fee Schedule (CLFS).
Join our panel of distinguished lab experts for an interactive discussion of the most crucial issues and challenges facing the industry under Medicare’s market-based payment system:

  • Review how Medicare payments for high volume, molecular and proprietary tests will change during 2018-2020
  • Identify which labs are the biggest winners & losers under Medicare’s revised CLFS
  • Find out the latest word from CMS on advanced diagnostic laboratory tests (ADLTs)
  • Understand how the elimination of ATP payments will result in legitimate hikes in reimbursement while “gaming” the system might cause serious compliance problems for labs
  • Determine how uniform lab payment rates regardless of geography will work to the advantage of some states
  • Assess how Medicare’s market-based pricing will affect lab payments under Medicaid, the Federal Employees Health Benefits Program, and private insurance plans
  • Obtain the latest status of ACLA’s lawsuit seeking that HHS publish a new rule that includes pricing data from all segments of the lab industry
  • Get answers to your specific questions about Medicare’s new lab payment approach