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Final Steps in Preparing for the PAMA Reporting Period (Part 2)

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:

  • Specific Procedure Code for each test
  • Each rate that each private payor allowed for that test
  • Volume at each private payor rate

Include:

  • Health insurance issuers (fully insured commercial, contracted and non-contracted)
  • Group health plans (ERISA/self-insured commercial)
  • Medicare Advantage plans
  • Medicaid managed care plans

Data Validation: cross-check system data to source data

  • Identify clerical payment posting errors and adjustments
  • Verify all reportable data has been captured

Analysis: review data quality and integrity

  • Determine if claim is fully adjudicated within data collection period
  • Identify payor adjudication errors that require redetermination, appeals, etc.

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.

Recommended Reading:

Now that the second data collection and reporting round is underway, make sure your laboratory is ready.

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Published by XIFIN
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