Webinar: The Bottom Line for Lab Reimbursement in 2019 – When All Is Said & Done With PAMA

The Bottom Line for Lab Reimbursement in 2019 – When All Is Said & Done With PAMA

Find out how CMS's decision requiring hospital outreach programs to report lab payment data starting next year will impact the second round of Medicare rate-setting under PAMA.

Following a year when Medicare slashed lab payments by a projected $670 million which resulted in payment cuts of 10% for may lab tests as required by the Protecting Access to Medicare Act (PAMA), industry executives are preparing for a second round of cuts beginning in January.

Significantly, CMS announced as part of its CY 2019 Physician Fee Schedule final rule that virtually all hospitals outreach labs that meet the volume thresholds will be required to report private-payer payment data under PAMA (January 1 to June 30, 2019.) Moreover, CMS is permitted to impose civil monetary penalties against labs required to report data, but fail to do so.

Meantime, the American Clinical Laboratory Association has stated it intends to appeal a federal judge's dismissal of its lawsuit over Medicare's new market-based pricing system. Finally, the court ruling has accelerated industry lobbying efforts on Capitol Hill to amend PAMA.

Here's just a sample of critical questions we'll answer as part of this "must-attend" 75-minute interactive session:

  • Why did a federal court throw out a PAMA lawsuit despite acknowledging that plaintiff's arguments on the merits raised important questions?
  • What were the key factors ACLA considered in deciding to appeal the court's dismissal of its lawsuit?
  • Can labs expect any relief from a second round of Medicare cuts under PAMA starting in January?
  • How will private-payor payments to labs in 2019 be impacted by Medicare;s market-based pricing system?
  • Now that CMS has broadened the definition of 'applicable lab' so that private payor data is collected from more hospital outreach labs, will there be a practical impact on Medicare rates going forward?
  • What are the major problems outreach labs are liable to encounter in reporting payment data to CMS beginning next year?
  • How much impact can labs expect in future Medicare pricing revisions when outreach programs are included in the data pool?
  • WHy might revised in-network national lab agreements with United and Aetna beginning in 2019 result in additional Medicare cuts for labs in the future?
  • What can labs expect from a record number of new lab codes in 2019 including Proprietary Laboratory Analysis (PLA) plus onerous medical necessity and prior authorization requirements?

Featured XIFIN Speaker

Lâle White
Executive Chairman & CEO

Additional Speakers

Hope Foster
Member & Chair
Health Care Enforcement Defense, Mintz Levin

Julie Khani
American Clinical Laboratory Association

Dennis Weissman
Dennis Weissman Associates, LLC

Laboratory Economics is the brainchild of Jondavid Klipp, a nationally recognized expert on the business of laboratory medicine. His research has appeared in numerous business and trade publications including the Wall Street Journal, New York Times and Medical Laboratory Observer.​


Medicare Market-Based Payment

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