CMS Gears up for Second PAMA CLFS Reporting Requirement

Publication Date: Jan 9, 2019

The second round of private payer payment data reporting by clinical laboratories to the federal government is fast approaching. The Protecting Access to Medicare Act of 2014 (See Section 216 here) requires clinical laboratories to submit to Centers for Medicare and Medicaid Services (CMS) data on the payment rates and test volume associated with those rates. While the reporting require does happen till next year (Jan. 1-March 31, 2020), CMS has announced that the second data collection period (the period where applicable information for an applicable laboratory is obtained from claims for which the laboratory received final payment during the period) has arrived. It will continue through June 30, 2019.

Once the data collection period concludes, laboratories will have till Dec. 31, 2019 to determine whether they are required to submit data and review and validate the information before it is reported to CMS. CMS will then use the submitted data to calculate new payment rates for implementation on January 1, 2021.

Given changes to the definition of an applicable laboratory brought about by the CY 2019 Physician Fee Schedule Final Rule, and recent comments from CMS that “it did not receive data from all laboratories required to report,” ASCP strongly recommends that every laboratory review the PAMA reporting requirements to determine if they must submit test payment and volume information.

In an effort to assist laboratories with these activities, CMS has scheduled a webinar for Jan. 22 to educate clinical laboratories about this year’s PAMA data collection requirements. Specific directions on data collection and data reporting can be found here.

Other articles in ePolicy News January 2019

ASCP’s NPQR Awarded QCDR Status by CMS for 2019

CMS Planning Significant Increase in CLIA Fees

Choosing Wisely to Recognize the ‘Champions’ Driving Innovation in Health Care

Sickle Cell Disease Bill Becomes Law

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

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