OIG suggests that Medicare enhances rate setting for clinical diagnostic tests in preparation for future public health emergencies


OIG suggests that Medicare enhances rate setting for clinical diagnostic tests in preparation for future public health emergencies

The Department of Health and Human Services’ Office of Inspector General recommended that the Centers for Medicare & Medicaid Services improve their approach to setting Medicare rates for clinical diagnostic laboratory tests under the Clinical Laboratory Fee Schedule and enhance communication with stakeholders in future public health emergencies. During the COVID-19 Public Health Emergency (PHE), CMS faced challenges in increasing testing capacity due to limitations in their standard rate setting procedures. Medicare Administrative Contractors were not able to set rates that adequately covered the cost of COVID-19 viral tests for all laboratories, according to the OIG report.

The OIG also noted that CMS may have missed opportunities to gather important information from laboratory associations and MAC pricing coordinators when making decisions about new Clinical Diagnostic Laboratory Test (CDLT) rates.

Improving how rates are set and increasing collaboration with stakeholders could help ensure that Medicare rates for clinical diagnostic laboratory tests are appropriate during public health emergencies. By addressing these issues, CMS can better support laboratories and patients during times of crisis.

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