Starting in January 2018, a federal law called Protecting Access to Medicare Act (PAMA) will take effect, resulting in cuts in Medicare Part B reimbursement to clinical laboratories on a scale that the U.S. lab industry has never seen before. Despite a pending lawsuit to stop implementation, the new payment system is now in effect and will result in reductions in reimbursement for many lab tests of up to 10 percent for each of the first three years (2018-2020) with only a small minority of test procedures seeing an increase. What PAMA does is to directly impact the “bottom-line” of virtually every lab, from the largest publicly traded reference labs to every hospital-based, physician office, and local & regional independent lab company in the country.

Course Objective:

• Learn how Medicare’s market-based rates will affect your laboratory in 2018
• Describe how Medicare payments for high volume lab tests will change during 2018-2020
• Assess how pricing for molecular testing and other specialty procedures will fare under Medicare’s new market-based methodology
• Understand how CMS is handling pricing for those test codes with insufficient private payor payment data available 
• Discover how CMS decided to handle automated test profiles (ATPs)
• Gain the latest guidance from CMS affecting advanced clinical laboratory tests
• Find out why the lack of hospital lab data resulted in lower Medicare market-based rates
• Determine how Medicare’s market-based pricing will directly impact lab payments under  Medicaid and even certain private payor rates
• Be aware of compliance “red flags” in the way labs handle billing for test profiles
• Get the latest intelligence on a pending legal challenge to prevent HHS from implementing the final market-based payment rule
• Find out about the lab industry’s 2018 legislative strategy to gain relief from Medicare’s new market-based pricing approach

Course Outline:

•   Overview of Medicare’s new lab payment system required by PAMA
•   How new market-based rates are calculated 
•   Phase-in of future payment reductions
•  CMS Regulatory Timetable  

•  Projected Medicare savings under PAMA
•  Status of pending lawsuit intended to block new rates from taking effect
•  What tests are experiencing the biggest cuts under PAMA 
•  2018-2020 payments for high volume tests
•  Representative payment amounts for molecular and other specialty tests
•  Identify which test categories are seeing higher payments 
•  What tests are projected to see biggest cuts under PAMA 
•  How CMS is handling payments for automated test profiles
•  Legitimate ways labs can benefit in billing for ATP
•  Compliance “red flags” for labs in developing custom profiles 
•  Definition of Applicable lab required to report data to CMS
•  Why most hospitals labs are excluded from providing data
•  Review of lab data collection and reporting requirements
•  Confidentiality issues surrounding lab data provided to CMS    
•  Why lack of hospital lab data is resulting in higher reductions under  market-based approach 
•  Defining Advanced Diagnostic Laboratory Tests (ADLTs)
•  Different reporting requirements for existing and new ADLTs
•  How to calculate existing and new ADLT payment rates                               
•  Latest CMS guidance relating to ADLTs
•  Why payment changes under PAMA will impact Medicaid lab payments
•  Impact of PAMA’s market scheme on private payer rates                                              
•  Compliance mandates including certification and penalties     
•  Role of PAMA advisory panel
•  Industry’s legislative strategy in 2018 to modify PAMA statute

What You Get:

• Training Materials
• Live Q&A Session with our Expert
• Participation Certificate
• Access to Signup Community (Optional)
• Reward Points

Who Will Benefit:

• Independent and hospital laboratory medical and administrative directors
• Laboratory executive management staff
• Laboratory administrative managers
• Laboratory section chiefs
• Physician office lab managers
• Head of lab reimbursement, billing & finance
• Lab legal & Compliance executives
• Senior executives involved with lab vendors
• Lab consultants