In our last post of this series, we identified “The First Steps in Preparing for the PAMA Reporting Period” as confirming your laboratory’s applicable lab status, executing an RCM data review, and assigning a project team and project team lead. Once you have carried out these steps, there are four additional steps to be taken before you complete your submission.
Step 4: Documentation
The fourth step is to begin compiling and sorting payment source documentation through aggregating applicable data from data warehouses and/or billing systems. This includes claims that meet the inclusion criteria as well as claims for which final payments where received within the data collection period. In addition, be prepared to provide access to your audited ERA and scanned paper EOB.
Step 5: Data Review
Now that your documentation is in order, your fifth step is to compile and review your data to ensure quality and integrity. Here is a checklist to keep you organized in your review:
Report “applicable information” for each CLFS test:
Data Validation: cross-check system data to source data
Analysis: review data quality and integrity
Step 6: Contracts
Before final submission, the sixth step is to review and renew contracts prior to the next collection period. This involves eliminating coupled contracts and evaluating fees for each CPT code to determine outliers that need to be re-negotiated.
Step 7: Authorize & Submit
Now you are ready for the seventh and final step — authorize and submit. At this stage, be sure format data for submission to the fee-for-service data collection and submit finalized, formatted CMS data at the appropriate time. For the next reporting period, you will have a window from January 1, 2020 to March 31, 2020 to submit.
For more information on the intricacies of PAMA reporting take a look at XIFIN Sr. Financial Analyst, Craig Young’s presentation on Key Recommendations for PAMA Reporting.