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PAMA Data Collection & Reporting – Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs (Part 1)

  • VP Product & Partner Marketing, XIFIN

Hospital and health system laboratories are under many of the same pressures as independent clinical laboratories. Compliance obligations and continued fee compression place a tremendous economic burden on many labs. While in the past, some hospital and health system leaders overlooked the economic value of the outreach lab, these leaders now recognize that outreach labs can add both strategic and financial value to the healthcare system.

At the same time, however, health system executives are trying to ensure that enterprise systems (such as electronic medical record (EMR) or electronic health record (EHR) systems) are used in as many different areas of the health system as possible to achieve its return on investment (ROI) for the multi-million dollar purchase (sometimes hundreds of millions of dollars).

As a result, hospital outreach and outpatient laboratory administrators often have enterprise RCM systems pushed on them by the health system. Unfortunately, what comes with the enterprise RCM system is the potential for compliance risk, additional labor costs to help meet the lab needs, and sub-par capabilities that don’t maximize the reimbursement due for the highly valuable work the lab performs.

In this 4-part series, we’ll be outlining the six key considerations for hospital outreach and outpatient lab administrators for selecting the best RCM system for the lab.

Does Your RCM System Enable Accurate Collection and Reporting of PAMA Data?

In the first PAMA data reporting period, few hospital labs were required to report. Since then, the definition of applicable lab has been modified, and hospital lab leaders should have already determined if they are now required under PAMA to collect and report on their lab data. If so, the data collection period began January 1, 2019, and collecting the data required to deliver an accurate dataset during the next reporting period needs to be underway.

Applicable laboratories that fail to report, or report data that is incomplete or incorrect face potential penalties of up to $10,000 per day, per line item.

Although the definition of applicable lab has been modified, it’s still unclear how many hospital labs will be required to report. Nor is it well-understood whether the additional data will have a meaningful impact on fee schedules going forward. It is also unknown whether hospital labs will be able to successfully distinguish outreach data from outpatient data, as is required. According to the American Hospital Association, it is a significant burden on hospitals to effectively distinguish this data. This process is especially difficult if the lab is using the hospital’s enterprise RCM system, as the level of detail required for PAMA reporting is often not collected.  

In addition to the capabilities required for regulatory reporting, laboratories need lab billing software that improves cash collections and delivers visibility into and control over financial operations. Purpose-built laboratory RCM systems provide the logic and automation to submit in a compliant manner and collect on smaller value claims with little or no manual intervention. Optimizing billing and accounts receivable processes, intelligently automating workflow, facilitating claim and appeal filing, and removing clerical decision making are keys to a hospital outreach lab’s success. You can learn more about these additional considerations in part 2 of this blog series.

In the meantime, we invite you to watch our webinar entitled “How Pairing a Purpose-Built Lab RCM System with Your Enterprise System Improves Health System Economics.” Guest speaker Mutaz Shegewi, Research Director from IDC, discusses how a purpose-built RCM improves cash collections while enhancing enterprise system investments with bi-directional data exchange.

Published by XIFIN
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