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- CMS Finalizes 2018 PAMA Pricing, Makes Post-Publishing Corrections, but Flaws Remain
CMS Finalizes 2018 PAMA Pricing, Makes Post-Publishing Corrections, but Flaws Remain
December 1, 2017The Centers for Medicare & Medicaid Services issued final clinical lab fee schedule prices for 2018 on November 17, 2017. Despite corrections made post-publication, XiFin, the American Clinical Lab Association (ACLA), and many other organizations believe the finalized rates remain fundamentally flawed.
These corrections include newly updated crosswalk and gap-fill determinations for a variety of test codes including molecular pathology, immunology, and genomic testing.
For example, the commonly used pharmacogenomic tests CYP3A4 and CYP3A5 that now have their own codes have been cross-walked to the code for CYP2C9 (81227), the lowest reimbursed code of the 3 main CYPs.
Although these latest changes do correct some of the problems encountered in the 2018 CLFS, underlying problems remain. In fact, today ACLA filed a lawsuit challenging the failure of the Acting Secretary of the Department of Health and Human Services (HHS) to comply with the data reporting requirements of Section 216 of the Protecting Access to Medicare Act (PAMA), and the unlawful exemption of the vast majority of laboratories from the requirement to report private payor data to the Centers for Medicare & Medicaid Services (CMS).
There is still time to take action and lend your voice to say the PAMA effort is flawed and needs reform. Visit the ACLA “take action” page to write or call Congress, tweet, or post on Facebook to have your voice heard.
At XiFin, we stand by our position that the laboratory industry cannot succeed by trying to cost-cut its way out of a revenue deficit created by PAMA. Laboratories and diagnostic providers need ways to maximize revenue, reimbursements, and cashflow. Revenue cycle management (RCM) solutions, including XiFin RPM 9 provide leading laboratories with the capabilities they need to optimize reimbursement revenue in a continuing battle against margin compression.