DHCS has just sent out a request for clinical labs to report their payment data for 2014. The request applies to clinical labs that received at least $100,000 in Medi-Cal payments on 2013. The request, a link is provided below, actually contains a list of the specific NPIs of providers who are required to respond. A laboratory is asked to provide payment data on about 380 clinical lab procedures which accounts for 80% of the payments for a procedure typically for their top five payer sources, not including Medicare or Medi-Cal. The complete instructions are contained in the link and includes an electronic submission format.

The notice, which was sent on January 30th, says the deadline for submission is February 27th which is an unreasonably short time for submission. We and other members of the clinical lab community have asked for that time to be extended and we expect that it will be extended another 30 or 60 days. We will keep you informed.

We continue to object to the methodology employed by DHCS in calculating the average lowest payment amount and their authority to add an additional 10% reduction to further reduce payment rates. We will continue to advocate for changes before the new methodology is implemented which DHCS is targeting for July 1st. Here is the notice and instructions for payment data submission.

The below link will take you to the updated Clinical Laboratories and Laboratory Services Rate Methodology Change webpage which includes new information regarding the 2014 data collection to be used for the development of reimbursement rates utilizing the new methodology. Also included you'll find the updated form for providers to submit data.

Thank you.

http://www.dhcs.ca.gov/provgovpart/Pages/CLLS.aspx 

For questions regarding the Fee Schedule Submission Form, please email: labcomments@dhcs.ca.gov.