Medicare`s New Market-Based Reimbursement System for Clinical Laboratory Testing: Tipping Point Ahead for U.S. Labs in 2018

Topics

• Overview of Medicare’s new lab payment system required by PAMA
• PAMA impact on local lab coverage decisions
• CMS regulatory timetable
• Definition of Applicable lab required to report data to CMS
• Projected Medicare savings under PAMA
• Lab data collection and reporting requirements
• Why most hospitals labs are excluded from providing data
• How new market-based rates are calculated
• Why less hospital lab data could result in higher reductions or all labs
• Phase-in of future payment reductions
• Which private payers are included in market-data approach
• Why payment changes under PAMA will impact Medicaid lab payments
• Illustrative example of maximum price reductions occur over 3 years
• Different reporting requirements for existing and new ADLTs
• Defining Advanced Diagnostic Laboratory Tests (ADLTs)
• Confidentiality issues surrounding lab data provided to CMS
• How to calculate existing and new ADLT payment rates
• Role of PAMA advisory panel
• Compliance mandates including certification and penalties
• What tests are projected to see biggest cuts under PAMA
• Options for calculating payments for lab panel payments
• Key OIG findings relating to PAMA implementation by CMS
• Identify test categories that may see higher payments
• Why PAMA’s market scheme may impact private payer rates
• Top remaining PAMA problems and concerns

Who should Attend

• CEOs
• Laboratory Presidents
• CIOs
• COO
• Senior Managers
• Administrative Directors
• Billing and Finance
• Head of Reimbursement
• Legal & Compliance Executives