Medicare Part B CLFS: Revised Information for Laboratories on Collecting & Reporting Data for the Private Payor RateBased Payment System

Section 105 (a) of the Further Consolidated Appropriations Act, 2020 (FCAA) (Pub. L. 116-94, enacted December 19, 2019) and Section 3718 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136, enacted March 27, 2020) made several revisions to the next data reporting period for CDLTs that aren’t Advanced Diagnostic Laboratory Tests (ADLTs) and the phase-in of payment reductions under the Medicare private payor rate-based CLFS. In summary the revisions are:

• We’ll base the next data reporting period of January 1, 2022, through March 31, 2022, on the original data collection period of January 1, 2019, through June 30, 2019.
• After the next data reporting period, there’s a 3-year data reporting cycle for CDLTs that aren’t ADLTs, (that is2025, 2028, and so on).
• The statutory phase-in of payment reductions resulting from private payor rate implementation is extended through CY 2024. There was a 0.0 percent reduction for CY 2021, and we won’t reduce payment by more than 15% for CYs 2022 through 2024.

Also, for the January 1, 2022, through March 31, 2022 (previously January 1, 2020, through March 31, 2020) data reporting period, we allow reporting entities the option to condense certain applicable information at the Tax Identification Number (TIN)-level, instead of reporting for each applicable laboratory individually at the National Provider Identifier (NPI) level.

MLN Matters Number: SE19006 Revised

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE19006.pdf