Starting July 2019, to comply with PAMA, medical laboratories are expected to analyze their private payor price data to help ensure clean, complete, and accurate reporting by March 31 2020.
The Centers for Medicare and Medicaid Services (CMS) did not implement fines with the first round of reporting, but that could change this round. In this second period of data collection, it’s becoming even more important for us to collect data accurately, precisely, and provide nearly perfect information on this because we can see the impact is fairly significant to our industry, and with payors ratcheting down their pricing, it’s becoming even more crucial.
January 1, 2016 – June 30, 2016: Labs collected the private payor amounts and volumes for all their tests.
January 1, 2017 – May 30, 2017: Labs reported the private payor amounts and volumes to CMS.
Late Summer/Early Fall: CMS published the draft 2018 Medicare rates.
January 1, 2018 – December 31, 2020: New Medicare rates in effect. Rates are equal to the median weighted private payor's rate (limited to a -10% year-over-year decline).
January 1, 2019 – June 30, 2019: Round 2 - Labs will collect the private payor amounts and volumes for their tests.
January 1, 2020 – March 31, 2020: Labs will report the private payor amounts and volumes to CMS.
January 1, 2021 – December 31, 2023: New Medicare rates go into effect. Rates are equal to the weighted median private payor’s rate (limited to a -15% year-over-year decline).
The data collection and reporting periods will repeat every three years indefinitely.
The implications of the new Protecting Access to Medicare Act (PAMA) that was released on June 2016 has caused growing concerns as it requires, starting January 1, 2017, laboratories and physician offices to report any payment information they receive from private payors. This new regulation will establish new compliance demands and transform the Medicare’s payment system for clinical laboratory testing.
Our Laboratory billing experts will help you empower in the ever-changing healthcare universe in order for you to comply with the new rules and succeed in the new reimbursement environment. We are there to help minimize any PAMA impact on your bottom line!
Bikham has designed its compliance solutions for laboratories that meet the needs of today’s margin challenged diagnostic environment. In order to manage and meet the high-volume data and transaction needs of laboratories we provide you with expert compliance and audit teams.
We deliver optimized billing for maximized revenue with:
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