This final rule, released on June 23, 2016 implements Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA). PAMA significantly revises the Medicare payment system for clinical diagnostic laboratory tests by requiring that Medicare payment for clinical laboratories be based on the weighted median of private payer rates along with a number of other provisions.
Laboratories are required to report HCPCS laboratory codes, associated private payor rates, and volume data if they have more than $12,500 in Medicare revenues from laboratory services on the Clinical Laboratory Fee Schedule (CLFS) and receive more than 50% of their Medicare revenues from laboratory and physician services during a collection period. The original deadline for reporting the first data set was March 31, 2017 but CMS announced a reporting extension until May 30, 2017. (See the Data Collection and Reporting section below for more information.) CMS will use this data to set Medicare payment rates effective January 1, 2018.
This website serves as a resource for AMP members to obtain detailed information on implementation.
CMS has published the preliminary payment rates and supporting documentation for the new private payor rate-based CLFS payment system. Click here for more information.
CMS also published the preliminary determinations for new codes that will be implemented on January 1, 2018. Click here for more information.
CMS is accepting comments on all preliminary determinations until October 23, 2017. Comments must be submitted electronically to the following address: CLFS_Annual_Public_Meeting@cms.hhs.gov.
To learn more about PAMA, please view AMP's archived webinar titled "The Who, What, and When of the PAMA Final Rule." To view the archived webinar, click here.
CMS has a website devoted to PAMA implementation. The website is updated frequently with sub-regulatory guidances, FAQs, etc.
Slides from CMS Webinar on Data Reporting - These slides provide important information on the data reporting process including vital information on how to register within the CMS Enterprise Portal. CMS states that this registration process will take some time so it is best to begin early! The live recording of this webinar is now available.
RECENT INFORMATION FROM CMS:
On March 30, 2017, CMS announced that it will exercise enforcement discretion until May 30, 2017, with respect to the data reporting period for reporting applicable information under the Clinical Laboratory fee Schedule (CLFS) and the application of the Secretary's potential assessment of civil monetary penalties for failure to report applicable information.
Click here for the full announcment from CMS.