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CodeMap® PAMA Update: Winners and Losers::Wednesday, April 25, 2018:: 2:00-3:15 pm ET

PAMA Update: Winners and Losers

CodeMap® Webinar
Wednesday, April 25, 2018
2:00-3:15 pm ET

As expected, the PAMA legislation and accompanying regulations resulted in significant cuts to the 2018 Medicare Clinical Laboratory Fee Schedule. PAMA also resulted in many other changes to how Medicare pays for clinical laboratory tests and procedures. This CodeMap® Webinar will examine the changes caused by PAMA and discuss which laboratories may benefit, and which laboratories will suffer. The following topics will be discussed:

  • Resultant Reimbursement: Unfortunately, because of PAMA, Medicare pays less for most clinical laboratory tests in 2018. However, those decreases are capped at 10% for this year. Also, Medicare now pays more for some tests and those increases are not capped. Some tests are now priced significantly higher. We will highlight which tests are winners and which tests are losers due to PAMA. We will also examine how PAMA changed the structure of the Medicare Clinical Laboratory Fee Schedule resulting in a single national fee schedule without geographic differences.  
  • PAMA Affects All Clinical Laboratories: We will examine how PAMA affects differing types of laboratories; hospital labs, reference labs, esoteric labs, and physician office labs. Some labs will win, and some will lose. Those on the losing side, must adapt quickly to survive.
  • Automated Test Panels: Pursuant to PAMA, CMS no longer bundles automated tests. As a result, a huge loophole now exists, which could result in some providers receiving far greater reimbursement for certain panels containing only automated tests. However, if providers game the system and do not take care to abide by medical necessity requirements, they may face significant false claims act liability. We will discuss this development and its ramifications for laboratories of all sizes.
  • The Future of PAMA: At least one lawsuit has been filed seeking to undo PAMA. In addition, many stakeholders believe hospital laboratories should report private payer data pursuant to PAMA. We will examine how external forces may shape the future of PAMA and how providers may be affected by possible changes.
  • PAMA - Next Steps: We will examine how providers must continue to comply with the PAMA regulations. PAMA requires laboratories to report private payer data every three years going forward. We will also discuss how CMS will set reimbursement for newly developed tests and procedures. Finally, we will explore how PAMA may affect not only Medicare reimbursement, but also private payer reimbursement. 

Price: $225.00

Video of Presentation and PDF Handouts.

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.