PAMA Lab Test Private Payor Rate Reporting—What Clinical Labs Need to Know Now to Avoid Future Penalties

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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.)

While not all hospitals are required to report, failure to report (or incomplete, inaccurate reporting) may trigger significant financial penalties.  Is your hospital required to report? Find out now in order to avoid penalties for next report of private payor rates, due in the first quarter of 2022.

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.

This informative webinar with an interactive Q&A session is a must-attend event for everyone in your hospital and lab team responsible for gathering, analyzing, and reporting data to CMS. You’ll get answers to your toughest questions and master the knowledge you need to report accurate and complete data on time.

Learning Objectives:

At the conclusion of the webinar attendees will be able to:

• 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.

Who should attend?

Hospital CEOs, CIOs, finance managers, revenue integrity managers, billing managers, patient financial services staff, compliance officers, and laboratory directors

Presenter:

Monica Lelevich, Director, Audit Services, PARA HealthCare Analytics, an HFRI Company

Monica joined PARA in March, 2012. Monica’s work for PARA includes regulatory analysis, oversight of claim reviews and coding projects, and conducting onsite reviews to optimize reimbursement through complete and accurate charge capture at the clinical department level. Her healthcare career began in 1995 as a managed care contract analyst for PeaceHealth. She advanced to Director, Contracts, overseeing both managed care contracts and physician clinical department directorship agreements. She demonstrated skill in process improvement as Director of PFS for PeaceHealth, Director of the Business Office for Kaiser Permanente Northwest, as Client Manager for McKesson Revenue Cycle Solutions, and as Revenue Cycle Director for St. John’s Medical Center in Jackson, WY.

Registration

This webinar is provided to participate in. Prior registration is required to ensure connection to the webinar.