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

Wednesday June 20 2018  10:00 AM PDT | 01:00 PM EDT

Training Duration = 90 Min                    Sponsored by Compliance Online

Click Here to register $349.00

Click Here to register and receive recording $199.00

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.

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

  • 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


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).