In order to assist the clinical laboratory community in meeting new Medicare reporting requirements under the Protecting Access to Medicare Act of 2014 (PAMA), CMS has posted a Clinical Laboratory Fee Schedule Data Reporting Template and a “Quick User Guide” to the template. By way of background, PAMA requires CMS to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts. We previously issued a client alert summarizing CMS’s June 23, 2016 final rule implementing the complex new PAMA clinical lab reimbursement framework.
In the Quick User Guide CMS notes that applicable laboratories (as defined) must collect private payor payment rates and associated volume for covered tests identified by HCPCS codes for the period beginning January 1, 2016 through June 30, 2016. Applicable laboratories must report specific data to CMS beginning January 1, 2017, through March 31, 2017, which CMS will use to calculate payment rates for calendar year 2018. The fields included in the template are: HCPCS Code, Test Name, Payment Rate, Volume, and National Provider Identifier.