Volume XVII
August 2021 - Top Stories:

1. Full Focus: Protecting Access to Medicare Act (PAMA)

After not having to report private payer data for clinical laboratory tests under the Protecting Access to Medicare Act (PAMA) since 2017, many lab owners are now working to brush up on reporting requirements with the next reporting round scheduled to begin in January of 2022. But how do you know if your lab is even required to report, and what's the best way to submit your collected payer data?

Read on in this month's Lab Insighter to gain a better understanding of the PAMA reporting requirements, the penalties you could face for failing compliantly report, and how this data will be used to set pricing for the Clinical Laboratory Fee Schedule moving forward.

2. Webinar: Preparing for PAMA Data Reporting

Legislative and public health emergency-related delays have pushed the next round of PAMA reporting back to Jan. 1 to March 31 of 2022, meaning labs must determine whether they are required to report and be prepared to do so compliantly in order to avoid monetary penalties.

During this webinar, you will learn:

  1. Who is required to report private payer data to CMS beginning in January 2022, including details on the volume and payment thresholds that mandate reporting.
  2. A breakdown of what information will be required for reporting labs and how to best collect and submit that data.
  3. Details on the recent MedPAC report to Congress, including whether a survey of labs could be adopted to reduce the overall reporting burden.
1. Trending Issue: How to Bill for Covid Variant Testing

With the recent proliferation of the Covid-19 Delta variant, we have been fielding more questions on the proper billing method for submitting claims where a sample was tested more than once for different variants. Unfortunately, this process has only been complicated by the fact that CMS is yet to publish explicit guidance for billing these tests.

In this video, Mick Raich, President of RCM Consulting for Lighthouse Lab Services, details best practices for ensuring your variant testing claims are both compliantly submitted and paid in a timely fashion.

2. How Surveillance Testing Can Help Slow the Next Covid Surge

Surveillance testing for Covid-19 is an important public health tool that provides a way to monitor for community or population-level outbreaks. When performed effectively, this testing helps to determine the effects of mitigation measures such as mask-wearing, social distancing, and vaccinations. And as schools re-open for the fall, many will likely be seeking options to efficiently monitor the health of their student populations.

If you're interested in learning more about surveillance testing, feel free to review the following resources:

Initially, the next round of reporting for payer data collected between January and June of 2019 was supposed to take place during the first quarter of 2020. However, legislative and public health emergency-related delays pushed the reporting schedule back two years. Now, between January and March 2022, labs are required to report data collected between January and June 2019.
After the initial reporting cycle in 2017, 75 percent of Clinical Lab Fee Schedule tests saw price reductions, with 58 percent having phased-in decreases because of the annual reduction cap.
The following article describes:

  • The payment thresholds that determine whether or not you must report PAMA data.
  • Details on specific pricing/test information labs will submit.
  • Why there has been such a significant gap between reporting periods, and when future cycles are expected to take place.

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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.
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