Reimbursement Concerns

Extract

ASCLS, through the vigilance of its Government Affairs Committee (GAC) members, the legislative consultant, and the executive vice president, watches for changes and developments in payment policies for laboratory services that will be of concern to our members. ASCLS' participation in collaborative efforts with other professional organizations, such as with the Clinical Laboratory Coalition, is another venue from which to watch for and comment on changes in reimbursement policy.

There are a number of areas of activity that are “heating up” at the moment, any of which could become an issue that would require a full-fledged advocacy effort by the ASCLS membership. Whether or not these are officially implemented remains to be seen, but they provide a snapshot of the type of activity that goes on continually and needs our attention.

Competitive bidding: One of the provisions of the Medicare Modernization Act (MMA) of 2004 was a Congressional mandate for the Center for Medicare and Medicaid Services (CMS) to conduct a competitive bidding project for clinical laboratory services. ASCLS has long vigorously opposed the concept of competitive bidding for laboratory services, holding that laboratory tests are services, not commodities. Quality and access are important features of laboratory testing and as important, or more important, than price.

To comply with the MMA legislation, CMS appointed a director of the project and hired a contractor, Research Triangle Institute, to plan and conduct the bidding process. The purpose of the demonstration is twofold:

• To determine whether competitive bidding can be used to provide…