During the COVID-19 pandemic, the Department of Health and Human Services’ Office of Inspector General highlighted the shortcomings in the Centers for Medicare & Medicaid Services’ (CMS) standard rate setting procedures. Specifically, CMS failed to allow Medicare Administrative Contractors to set rates that adequately covered the cost of conducting COVID-19 viral tests for all laboratories.
The OIG also noted that CMS may have missed opportunities to gather crucial information from laboratory associations and MAC pricing coordinators when making decisions about new Clinical Laboratory Fee Schedule rates. This lack of communication and collaboration could have hindered efforts to increase testing capacity during the public health emergency.
Moving forward, the OIG suggested that CMS should revisit their rate-setting procedures and improve communication with stakeholders to ensure that Medicare rates for clinical diagnostic laboratory tests are appropriate and sufficient during future public health emergencies. By actively engaging with laboratory associations and MAC pricing coordinators, CMS can better understand the needs and challenges faced by laboratories and make informed decisions to support testing efforts.
