Upcoming SDAHO Education

Participants that attend will:

• Be presented with statewide and national data.
• Learn about substance use treatment services that are available for clients within the Division of Behavioral Health system.
• Become familiar with services that are available through the Avoid Opioid campaign and MAT services in South Dakota.

Protecting Access to Medicare Act (PAMA) requires applicable laboratories to report private payer rates for clinical laboratory services to the CMS; the data is necessary to calculate Medicare reimbursement rates for tests on the clinical laboratory fee schedule. In 2018, CMS included hospital “outreach” laboratories which submit claims for non-patient services to the list of entities that must report private payor data (if the hospital did more than $12,500 in specimen-only business with Medicare.)

Hospital laboratories could face considerable risk if not compliant with the latest PAMA requirements. Reporting inaccurate information could result in continuing downward adjustments to the Clinical Laboratory Fee Schedule — carrying far-reaching budget implications for hospitals, physician practices, and independent laboratories.

Learning Objectives:

• Comprehend the CMS’ mandate for Lab PAMA reporting – who, what, why, and when
• Recognize whether your hospital is required to report at all
• Evaluate the organizational ability to collect and calculate the required data
• Anticipate the consequences are for failure to report timely, accurate, and complete private payor data to CMS within the required reporting period.