Medicare's New Market-Based Reimbursement System for Clinical Laboratory Testing: Tipping Point Ahead for U.S. Labs in 2018

Instructor: Dennis Weissman
Product ID: 705232
Training Level: Basic to Intermediate
  • Duration: 90 Min
This online training will cover PAMA mandates, CMS regulatory requirements, guidance and related government reports on implementing a new Medicare market-based Part B fee schedule for laboratory services.

recorded version

1x Person - Unlimited viewing for 6 Months
(For multiple locations contact Customer Care)
Recorded Link and Ref. material will be available in My CO Section
Last Recorded Date: Nov-2017

Training CD / USB Drive

One CD/USB is for usage in one location only.
(For multiple locations contact Customer Care)
CD/USB and Ref. material will be shipped within 15 business days

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Read Frequently Asked Questions

Why Should You Attend:

This webinar details the methodology and related requirements adopted by CMS for developing a revised Medicare Clinical Laboratory Fee Schedule (CLFS) using rates paid by private health insurance companies, Medicaid Managed Care Organizations and Medicare Advantage plans. Key changes covered include the market-based data approach that Medicare uses to set payment rates; the switchover to a national fee schedule creating a single payment rate nationwide for each test without local variation; and the creation of a new category of tests, Advanced Diagnostic Laboratory Tests (ADLTs) and the different pricing methods and reporting periods for existing and new ADLTs.

An analysis will be presented of projected lab pricing changes under the Medicare market-based system starting in 2018 along with its expected impact on commercial payer lab rates.

Learning Objectives:

  • Find out how Medicare rates for high volume tests will change in 2018
  • Determine how higher-priced payments for genetic & molecular tests will fare under the new market-based Clinical Laboratory Fee Schedule
  • Discover which tests registered the largest reductions and those that recorded the highest increases under the preliminary pricing scheme
  • Understand how CMS is handling pricing for those test codes with insufficient private payor payment data available
  • Assess the position of CMS about pricing automated test panels under its revised Medicare payment scheme
  • Learn about the latest guidance relating to Advanced Diagnostic Laboratory Tests (ADLTs)
  • Explain the process for commenting on the preliminary PAMA market-based payment rates and its impact on final CMS pricing decisions

Areas Covered in the Webinar:

  • Overview of Medicare’s new lab payment system required by PAMA
  • CMS regulatory timetable
  • PAMA impact on local lab coverage decisions
  • Projected Medicare savings under PAMA
  • Definition of Applicable lab required to report data to CMS
  • Why most hospitals labs are excluded from providing data
  • Lab data collection and reporting requirements
  • Why less hospital lab data could result in higher reductions or all labs
  • How new market-based rates are calculated
  • Which private payers are included in market-data approach
  • Phase-in of future payment reductions
  • Illustrative example of maximum price reductions occur over 3 years
  • Why payment changes under PAMA will impact Medicaid lab payments
  • Defining Advanced Diagnostic Laboratory Tests (ADLTs)
  • Different reporting requirements for existing and new ADLTs
  • How to calculate existing and new ADLT payment rates
  • Confidentiality issues surrounding lab data provided to CMS
  • Compliance mandates including certification and penalties
  • Role of PAMA advisory panel
  • Options for calculating payments for lab panel payments
  • What tests are projected to see biggest cuts under PAMA
  • Identify test categories that may see higher payments
  • Key OIG findings relating to PAMA implementation by CMS
  • Top remaining PAMA problems and concerns
  • Why PAMA’s market scheme may impact private payer rates

Who Will Benefit:

  • Laboratory Presidents
  • CEOs
  • COO
  • CIOs
  • Administrative Directors
  • Senior Managers
  • Head of Reimbursement
  • Billing and Finance
  • Legal & Compliance Executives
Instructor Profile:
Dennis Weissman

Dennis Weissman
President, Dennis Weissman and Associates LLC

Dennis Weissman, A nationally recognized, independent analyst and thought leader in the diagnostic field for over three decades, Dennis is President of Dennis Weissman & Associates, LLC, Falls Church, VA, a consultancy which provides market intelligence, M&A advisory services, business leadership and public policy advice to diagnostic and life science companies and organizations. He has expertise in Medicare and health care reform policies and trends; clinical lab and pathology payment & compliance policies as well as business trends affecting the diagnostic sector. Dennis founded and served as publisher of Washington G-2 Reports (now G2 Intelligence) through 1999, an information company that reports on and analyzes the U.S. clinical laboratory industry via newsletters, research reports and conferences. Prior to G2, he served as the Director of the Washington Office of the American Society for Medical Technology (now ASCLS) and before that, Special Assistant to the Deputy Assistant Secretary for Health, Department of Health, Education & Welfare (now HHS).

Topic Background:

As the largest single purchaser of clinical lab services in the U.S., Medicare now pays over $7 billion annually under Medicare Part B for testing provided in a wide variety of provider settings including hospitals, independent labs and physician offices & clinics. CMS estimates that the new payment system will save Medicare $3.9 billion over 10 years and thus the bottom-line every provider billing Medicare for lab tests will be directly affected by this new payment system. CMS has already issued final PAMA rules and guidance that includes identifying which labs must turn over private payer data to the government that will form the basis of Medicare’s new market-based fee schedule. Beginning in 2018, all labs will be paid the revised Medicare rates for more than1100 diagnostic tests. Moreover, since many commercial payers have historically set their lab payments at a percentage of Medicare allowable rates, they will likely adjust their lab payment rates in line with Medicare’s new market-based pricing.

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Refund Policy

Registrants may cancel up to two working days prior to the course start date and will receive a letter of credit to be used towards a future course up to one year from date of issuance. ComplianceOnline would process/provide refund if the Live Webinar has been cancelled. The attendee could choose between the recorded version of the webinar or refund for any cancelled webinar. Refunds will not be given to participants who do not show up for the webinar. On-Demand Recordings can be requested in exchange.

Webinar may be cancelled due to lack of enrolment or unavoidable factors. Registrants will be notified 24hours in advance if a cancellation occurs. Substitutions can happen any time.

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