The First Cut Isn’t The Deepest: Proposed Clinical Lab Fee Schedule Under PAMA

Cardinal Health Lab Briefings webinar series

This webinar is presented by Chandra Branham, J.D., VP of Payment & Healthcare Delivery Policy, AdvaMed & Julie Khani, President, ACLA.

Title: The First Cut Isn’t The Deepest:  Proposed Clinical Lab Fee Schedule Under PAMA

Overview

On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA). This legislation creates a single, national fee schedule which is based upon private payor rates.  Applicable laboratories performing clinical diagnostic laboratory tests had to report the amounts paid by private insurers for laboratory tests. Medicare then used the weighted median of private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning January 1, 2018. 

CMS initially estimated that using a market-based system stipulated under PAMA would save $390 million in the first year of 2018, and $3.93 billion over a decade¹. In September 2017, CMS released the proposed new rates and the rate cuts are more significant than originally anticipated. The proposed rate structure would result in reductions of $670 million in Part B program payments for clinical lab fee schedule (CLFS) tests in 2018². The preliminary rate schedule introduces dramatic cuts. 58% of tests will have reductions phased in over multiple years as the preliminary rates exceed the maximum per year reduction³.

This new rate structure represents a dramatic shift in the way laboratory tests are reimbursed.  This webinar will provide clinical laboratories with an update on the implementation of the new Clinical Lab Fee Schedule and the financial impact to clinical labs.

Objectives

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

1. Discuss the changes to payment rates for tests paid on the Clinical Lab Fee Schedule.
2. Identify the 2018 payment rates for CPT codes including which codes are increasing/decreasing.
3. Recognize which CPT codes will have phased in rate reductions due to per annum caps.
4. Identify the payment changes to panel based tests, molecular diagnostic tests, etc.
5. Illustrate the impact to your clinical laboratory based upon the 2018 rates.

Intended audience

This continuing education credit is intended for use by clinical laboratory professionals who are interested in learning about the implementation of the new Clinical Lab Fee Schedule and the financial impact to clinical labs.

Take the course and obtain CE credits

Attend this basic level webinars at no cost.  Cardinal Health is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E.® Program.  This webinar is managed by Whitehat Communications and offer one P.A.C.E.® Continuing Education contact hour for up to six months after the live event.

One P.A.C.E.® credit is available upon completion of the course: The First Cut Isn’t The Deepest:  Proposed Clinical Lab Fee Schedule 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.