April 14, 2016
NILA Requests Meeting With CMS to Discuss PAMA Regulations
NILA and several NILA health system laboratories, along with a half dozen other laboratory associations, are requesting a meeting with CMS officials to discuss the inclusion of hospital private payor data in the calculation of PAMA’s “weighted median” for each laboratory test that will establish PAMA’s new Clinical Laboratory Fee Schedule (CLFS) payment rates.
Under CMS’s proposed PAMA regulations, published October 1, 2015, the overwhelming majority of hospital laboratories would be prohibited from providing data to CMS about private payor rates for clinical laboratory tests that they furnish.
Since the hospital private payor rates are generally much higher than the discounted rates paid to the largest independent clinical laboratories, excluding these data will bias the calculation of the weighted medians downward.