OIG Mentions Need for Co-pay

The Department of Health and Human Services (HHS) recently released its annual Compendium of Unimplemented Recommendations, which identifies the top 25 unimplemented recommendations that, if adopted, would reduce government healthcare costs and improve patient care.  Two recommendations affecting clinical laboratories are:

• The re-establishment of 20 percent Medicare co-payment for clinical laboratory services; and
• The update of the clinical laboratory fee schedule to ensure Medicare program rates are aligned with what physicians pay for clinical laboratory tests.

According to the Office of Inspector General, these changes would save the government nearly $24 billion.  AACC has long opposed the re-instatement of the co-pay, which can significantly increase the administrative burden and costs on clinical laboratories.  There are currently no legislative efforts to enact this change.  The recommendation to align lab fees with the amount paid by physicians is most likely referring to the lowest-price concept, which is the basis for PAMA. Therefore, this recommendation may, in fact, be implemented.

AACC will continue to voice its opposition to the clinical laboratory co-payment, which could impede access to testing for some Medicare beneficiaries.