OIG recommends Medicare improve rate setting for clinical diagnostic tests for future public health emergencies

For future public health emergencies, the Centers for Medicare & Medicaid Services should improve how it sets Medicare rates for clinical diagnostic laboratory tests under the Clinical Laboratory Fee Schedule and communicates with stakeholders involved in setting the rates, the Department of Health and Human Services’ Office of Inspector General advised last week. When CMS was working to increase testing capacity during the COVID-19 PHE, CMS’s standard rate setting procedures did not allow Medicare Administrative Contractors to set rates that were adequate to cover the cost of conducting COVID-19 viral tests for all laboratories, OIG said. In addition, OIG said CMS may have missed opportunities to obtain important information from laboratory associations and MAC pricing coordinators when it made decisions about the new CDLT rates.