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THE PROTECTING ACCESS TO MEDICARE ACT (PAMA):
REDUCED PAYMENTS TO LABORATORIES IN 2018
By Irwin Z. Rothenberg, MBA, MS, CLS(ASCP), Technical Writer / Quality Advisor, COLA Resources, Inc.
The Protecting Access to Medicare Act (PAMA) includes
the most extensive reform of the Medicare Clinical
Laboratory Fee Schedule (CLFS) since it was established
in 1984. Signed into law on April 1, 2014, PAMA was
intended to introduce market-based pricing to the
Medicare CLFS. PAMA was passed after it was
discovered by the Health and Human Services’ Office of
Inspector General (OIG) that Medicare paid significantly
more for clinical laboratory tests than commercial
payers, and in some cases, Medicaid.
Under PAMA, CMS required all “applicable
laboratories” to report their private payer rates on a test-
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by-test basis along with associated test volumes if they
met the following thresholds over a 6-month period from
January 1, 2016 through June 30, 2016:
• Have more than $12,500 in Medicare revenues from
laboratory services on the CLFS; and
• Receive more than 50 percent of their Medicare
revenues from laboratory and physician services
during a data collection period.
The data had to be reported to CMS by March 31, 2017,
and if the laboratories did not report the data, they would
be subject to severe penalties and fines. However, CMS
did extend the reporting deadline to May 30, 2017.
www.PhysiciansOfficeResource.com