Beginning in 2017, the Protecting Access to Medicare Act (PAMA) requires certain laboratories to collect and submit private payor rates for clinical laboratory tests. Medicare will use the data it collects to set the fees for these tests starting in 2018. In addition to advocating on behalf of pathologists on PAMA, the CAP is providing additional information to help pathologists and laboratories understand who is required to submit data, deadlines for collection and reporting, and additional resources to comply with new rules. Listen to the CAP's PAMA podcast and download the podcast presentation slides (PDF, 180 KB).
Medicare Implements PAMA Reforms, Publishes 2018 CLFS Rates
The Medicare program published the 2018 CLFS utilizing a new methodology based on private payer rates for tests collected from a small segment of providers. The CAP has called this collection process flawed and continued to urge the Centers for Medicare & Medicaid Services (CMS) to delay the implementation of the new fee schedule.
As a service for CAP members, the CAP analyzed the impact of the top 100 Healthcare Common Procedure Code System (HCPCS) CLFS codes by volume, which represent 80% of total CLFS spending. Download the 2018 CLFS impact table.
CAP Advocates for Changes to PAMA Data Collection
Citing adverse impacts to laboratories and patients, the CAP strongly advocated for improvements to how CMS collected data from laboratories. The CAP, along with other organizations within the laboratory community, met with Department of Health and Human Services (HHS) officials to urge the agency to delay the implementation of PAMA. The program rules excluded the vast majority of laboratories, including many hospital-based laboratories, from reporting private payer market data. Although most laboratories are excluded from reporting, the new CLFS rates will apply to all laboratories, including physician office laboratories, in 2018. The CAP sent the CMS additional comments that outline concerns from its members on October 23, 2017.
- PAMA Regulations and 2018 CLFS Rates
- Guidance to laboratories for collecting and reporting data for the private payor based payment system.
- PAMA Data Collections System User Guide from the CMS.
- PAMA frequently asked questions from the CMS.
- PAMA Submission Process and Data Certification
- Reporting Data to Meet PAMA Requirements (PDF, 126 KB)