Solid reporting from all applicable laboratories is the key to mitigate future PAMA fee schedule cuts. This means labs need to be able to report on actual allowables vs. payments, validate the accuracy of payments, and optimize appeals activity to avoid under-reporting payments. All applicable labs are included in the current data collection period now underway for the first half of 2019.
Step 1: Status Confirmation
To properly prepare for the next PAMA reporting period the first step must be to confirm your applicable lab status. In order to be considered an applicable lab, labs must meet the following criteria as of January 1, 2019 (see CMS Rules for reference):
Step 2: RCM Data Review
Once you have confirmed your lab’s applicable status the second logical step in your preparation should be ensuring your revenue cycle management solution (RCM) can provide the required details. Here are some keys to consider when executing your RCM data review:
RCM system must routinely capture data to:
RCM systems must also be able to capture:
Step 3: Project Team
Now that you have made sure your system is up to par, the same needs to be done for your personnel. The third step is creating a project team to prepare for data submission should be your third step in the preparation process. Be sure to assign authority to a project leader who will sign off on final submission. This project lead should designate individuals for data collection and review, including:
So far we’ve covered the first three steps in preparing for PAMA reporting, but there are a few more crucial steps to this process. Check out part 2 of this blog series titled: Final Steps in Preparing for the PAMA Reporting Period (Part 2).
Want more information on how to prepare for PAMA? Take a look at this recent Executive War College presentation by XIFIN Financial Analyst, Craig Young titled: Key Recommendations for PAMA Reporting