PAMA Solution
Comprehensive Diagnostics and Innovative Testing Services
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.
PAMA Schedule
The data collection and reporting periods will repeat every three years indefinitely.
With Bikham Healthcare by your side Shield yourself from the PAMA Effect
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:
- Unparalleled managing services
- Automated business rules and workflows
- Visibility into business intelligence
- Managed medical claims filing that ensures upfront, clean claim submissions in the shortest possible time.
- Visibility into Business intelligence to make informed business decisions
Bikham helps laboratories and diagnostic service providers to maximize their operational efficiencies, reimbursements, and revenue opportunities to satisfy regulatory requirements in order to help them succeed in the new paradigm. We help you improve your position for the future.
PAMA Frequently Asked Questions
- Inpatients
- Outpatients
- Non-Patients ("Outreach")
- Point of Care/Traditional Tests
- Provider-Performed Microscopy
- Pathologists' Practices
- Standard Tests
- Drug Abuse Testing
- Molecular Diagnostics
Some of the applicable laboratories are
Hospital Labs:
Physician Office Labs:
Independent Labs:
The $12,500 threshold rate does not apply to a laboratory that furnishes an ADLT, but strictly applies to any CDLT that a laboratory may perform.
CMS was involved in the proposal responsible for altering payment rates. The proposal was linked to the Congress passing the first major reform of the CLFS in the April of 2014, later named as PAMA.
The responsibility to develop and clarify definitions of key terms, determine the right times to report private payor rates, create a technology platform capable of processing millions of data, and establishing coding processes for the new tests lies with the CMS.
As per PAMA, laboratories are required to report private payor rates, other than the price concessions. The reimbursement made by payors for lab services for each lab test adds up to a lot of data. Labs are also required to include any changes in the rate during the billing period.
All this data is required for each test on the menu other than the unlisted CPT codes. An attestation by an executive of the reporting entity stating the accuracy and completeness of submitted information must also be made.
Prior to submitting any information, the reporting entities are required to register in the Enterprise Identity Management system and request a CLFS role (submitter or certifier) in the Fee-for-Service data collection system. The reporting executive must be certified in PECOS as an authorized user on the Medicare Enrollment forms. Names of such executives appear within one of the following 855 application forms:A, B, C, I, or R.
With the latest fee schedule in place and complex reporting obligations, it is important to have a financially stable RCM system that offers you the required visibility and auditability. A system that is able to capture the following information and aggregate it into buckets is of the utmost importance.
Date of Payment.
Payor Type.
Number of Tests conducted for each line item.
Allowed Amount, Payment made by the payor and the Patient Responsibility.
Contractual rates including volume and other discounts.
Therefore, incorporating such an efficient system can be something you would want to do for your lab practice.
