Medicare Punishes Labs With Slow COVID-19 Test Turnaround

Speciality News

WASHINGTON — Medicare is clamping down on clinical labs that fail to return COVID-19 test results fast enough.

“CMS previously took action in April 2020 by increasing the Medicare payment to laboratories for high throughput COVID-19 diagnostic tests from approximately $51 to $100 per test. Today, CMS is announcing that starting January 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected,” CMS said in a press release Thursday. “Also effective January 1, 2021, for laboratories that take longer than two days to complete these tests, Medicare will pay a rate of $75. CMS is working to ensure that patients who test positive for the virus are alerted quickly so they can self-isolate and receive medical treatment.”

“As America continues to grapple with the COVID-19 pandemic, prompt testing turnaround times are more important than ever,” said CMS Administrator Seema Verma. “Today’s announcement supports faster high throughput testing, which will allow patients and physicians to act quickly and decisively with respect to treatment decisions, physical isolation, and contact tracing.”

Turnaround times for COVID-19 lab tests have been a matter of contention in many states. TV station WXYZ in Detroit recently reported on a man who had to wait 6 days to get his test results, even though he had been told it would take 3 days. Quest Diagnostics announced that as of Oct. 12, its turnaround time is “2 days across all populations and 1-2 days for our priority population, which includes hospitalized patients, individuals in long-term care (such as nursing homes), and presurgical patients.”

Not surprisingly, laboratories were not happy with the CMS announcement. “ACLA member laboratories have already implemented innovative solutions and reworked operations to support increased COVID-19 testing capacity and faster turnaround times,” the American Clinical Laboratory Association said in a statement. “We’re concerned this policy could create a domino effect where patient access to testing is severely reduced. Cutting laboratory reimbursement won’t address the root causes of delayed turnaround times. Turnaround time is driven largely by fluctuations in demand and access to critical supplies. As states across the country experience a surge in new cases, the global demand for testing supplies remains high.”

America’s Health Insurance Plans (AHIP), the lobbying group for the private health insurance industry, was a little more positive. “Every American deserves access to the tests they need to diagnose COVID-19, and to the treatment they need to recover from the virus,” the group said in a statement. “Health insurance providers are working every day to satisfy that commitment. Delays in obtaining results can pose a risk to Americans, their families and others, as well as unnecessary self-isolation. We support CMS’s action to use incentives to improve the rapidity of COVID-19 test results, but it will be important for CMS to monitor the policy and ensure it does not have adverse impact on access to tests or the quality of the results.”

AHIP did not respond when asked whether its members were using similar incentives to those announced by CMS. The Blue Cross and Blue Shield Association said policies on testing reimbursement would “vary per Blue Cross and Blue Shield company.” Anthem, one of the larger Blue Cross Blue Shield insurers, did not respond when asked for comment.

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    Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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