Articles and Blogs

PAMA

Reminder: Many Hospitals Will Be Required to Report Lab Price Data as Part of PAMA Changes

[09/03/19]

Posted on September 3, 2019 in Health Law News

Published by: Hall Render

In 2014, Congress enacted the Protecting Access to Medicare Act (“PAMA”), changing the landscape of Medicare reimbursement for lab services. PAMA required the Centers for Medicare & Medicaid Services (“CMS”) to establish a single, national Clinical Laboratory Fee Schedule (“CLFS”) based on current charges in the private health care market. Below, we provide background... READ MORE

Tags: , , , , , , ,

Appropriate Use Criteria for Advanced Diagnostic Imaging – Testing Period Begins Soon!

[08/26/19]

Posted on August 26, 2019 in Health Law News

Published by: Hall Render

In late July 2019, CMS issued claims processing requirements for the educational and operations testing period for appropriate use criteria (“AUC”) related claims for advanced diagnostic imaging. Advanced imaging includes CT, PET, nuclear medicine, and MRI. The testing period begins January 1, 2020. The CMS Program Transmittal can be found here. Background The Protecting... READ MORE

Tags: , , , , ,

GAO Lab Report – Sound Analysis? Criticism from Senator Grassley and Others and CMS’s Response

[05/20/19]

Posted on May 20, 2019 in Health Law News

Published by: Hall Render

In November 2018, the Government Accountability Office (“GAO”) released a report (“Report”) on new laboratory payment rates established by CMS under the Protecting Access to Medicare Act (“PAMA”). In the Report, the GAO analyzed Medicare claims data to assess how CMS’s implementation of these new rates will impact Medicare expenditures and recommended CMS take... READ MORE

Tags: , , , ,

Clinical Diagnostic Labs Enter a New Collection and Reporting Period as Medicare Payment Updates Continue

[01/18/19]

Posted on January 18, 2019 in Health Law News

Published by: Hall Render

January 1, 2019 marked the start of a new data collection period for laboratories pursuant to the Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule (“CLFS Rule”).¹ The CLFS Rule establishes the Centers for Medicare & Medicaid Services’s (“CMS’s”) new private payor-based rate-setting system for clinical diagnostic laboratory tests (“CDLTs”) paid under the... READ MORE

Tags: , , , , , , , , , ,