Clinical Lab Payment Reform under PAMA

Reimbursement, Reporting and your New Responsibilities

Cardinal Health Lab Briefings webinar series

This webinar is presented by Chandra Branham, Vice President of Payment & Healthcare Delivery Policy at AdvaMed and Julie Khani, Executive Vice President at ACLA.


On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) released a Final Rule implementing Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning January 1, 2018.1

The Final Rule not only reforms reimbursement for clinical laboratory testing but also has numerous requirements and components that laboratories need to understand and comply with.  Noncompliance with these new requirements can have financial impacts on the laboratory/institution. Defined within the legislation are elements such as:

  • Definition of applicable laboratories required to report to CMS
  • Reporting periods, applicable information to be reported, and designated reporting authorities
  • Definition of advanced diagnostic laboratory tests (ADLTs) and how they differ in reporting and rate setting

This presentation will address important provisions of the law, including the new data reporting responsibilities for applicable laboratories, details about and timeframes for reporting private payer information, and information on the annual rate reductions allowed under the legislation. The presentation will also help laboratories translate the Final Rule to identify required actions and potential impacts for their laboratories. 

1 PAMA Regulations, CMS, September 19, 2016



Upon completion of this continuing education activity, the participant should be able to:

  • Interpret the provisions of the Final Rule of Section 216 of PAMA which reforms payment to laboratory tests paid under the Clinical Lab Fee Schedule.
  • Identify and apply the new reporting responsibilities for their laboratory and understand the reporting timeframes and the impact it will have on their laboratory.
  • Recognize the methodology and opportunities to engage with CMS on the proposed payment rates before they become final.


Intended audience

This continuing education credit is intended for use by clinical laboratory professionals who are interested in learning more about the provisions of the Final Rule of Section 216 of PAMA and identifying required actions and potential impacts for their laboratories.


Take the course and obtain CE credits

Attend this basic level webinars at no cost. This webinar is managed by Whitehat Communications and offer one P.A.C.E.® Continuing Education contact hour1 for up to six months after the live event.

One P.A.C.E® credit is available upon completion of the course: Clinical Lab Payment Reform under PAMA.

P.A.C.E.® credits are widely recognized in the clinical laboratory profession and can be used to fulfill most continuing education requirements.

1 Whitehat Communications is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E.® Program.