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CLFS Payment Toolkit

What You Need to Know

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What is the CLFS?
The Clinical Laboratory Fee Schedule (CLFS) is the primary way that Medicare communicates payment rates for clinical diagnostic services. The CLFS lists payment rates for nearly 2,000 different lab tests that are available to Medicare beneficiaries.
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How are payment rates set for new lab tests?

Once each year, usually in late June, CMS welcomes manufacturers of new lab tests to present information supporting a national CLFS payment rate for the test in the following year.

After the public meeting, CMS convenes its CLFS Advisory Panel, made up of industry experts to provide an addition point of reference that can be used by CMS to establish payment rates.
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How long does it take to get a price under the CLFS?

From start to finish, our meticulous process takes a minimum of 12 months. Beginning with a thorough evaluation of your test, we delve deep into understanding its intricacies, costs, and execution. Our expert team then determines an appropriate CLFS payment rate tailored to your specific test, while devising a compelling strategy to convince CMS. We leave no stone unturned in developing and effectively communicating our pricing decision to CMS, diligently following up to ensure that your test receives the favorable payment it deserves. At Gettysburg Healthcare Consulting, we are dedicated to being your trusted Medicare and Medicaid policy professionals, guiding you through every step of this intricate journey.

Download our FREE CLFS Timeline Infographic (PDF format)

What do I need to do to get my test priced?

If you want to get CLFS payment for your new test, you’ll need to acquire a unique HCPCS code for your laboratory test. Once you’ve obtained the code, be prepared to explain the costs, resources, and clinical staff needed for your test, along with any other relevant data that can support the price. At Gettysburg Healthcare Consulting, our experienced team has successfully assisted numerous companies in obtaining pricing from Medicare. We are ready to provide the guidance and support you need to navigate this process effectively.

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How can we help?
At Gettysburg Healthcare Consulting, we have assembled a team of Medicare and Medicaid policy pros who are dedicated to providing top-notch consulting services. With years of experience and in-depth knowledge, our team is committed to helping you navigate the complex world of healthcare policy. Whether you need assistance with compliance, reimbursement, or strategic planning, our experts are here to guide you every step of the way. Trust Gettysburg Healthcare Consulting for all your healthcare consulting needs.

Our Expertise in CLFS Payment Shines

  • Working with an experienced healthcare consultant with over 30 years of experience with the Medicare program provides you with a level of knowledge and skill unmatched in the industry.
  • Our comprehensive understanding of AMA coding rules and requirements will help to avoid pitfalls and mistakes that might occur.
  • Clients trust us to review their novel diagnostics and determine the best coding approach for their unique needs.

FAQ

Our Expert Team
At Gettysburg Healthcare Consulting, we have assembled a team of Medicare and Medicaid policy pros who are dedicated to providing top-notch consulting services. With years of experience and in-depth knowledge, our team is committed to helping you navigate the complex world of healthcare policy. Whether you need assistance with compliance, reimbursement, or strategic planning, our experts are here to guide you every step of the way. Trust Gettysburg Healthcare Consulting for all your healthcare consulting needs.
Why Choose Gettysburg Healthcare Consulting?
At Gettysburg Healthcare Consulting, we are the experts when it comes to Medicare and Medicaid policy. With years of experience in the industry, our team of professionals is dedicated to helping healthcare providers navigate the complex world of healthcare regulations. We understand the challenges you face and are committed to providing you with the knowledge and guidance you need to succeed. Trust the policy pros at Gettysburg Healthcare Consulting to help you achieve your goals.
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