Medicare's New Market-Based Pricing System for Clinical Diagnostic Laboratory Services

  • Speaker:Dennis Weissman
  • Date: 7th February 2018 10:00 AM PST | 01:00 PM EST
  • Duration:90Min
  • Product Code:GRC-90211



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This online training will cover Medicare’s new market-based payment system mandated by PAMA for clinical diagnostic laboratory tests including final 2018-2020 payment rates released by CMS, regulatory requirements, guidance and related government reports on implementing a new Part B fee schedule for lab services, and the winners and losers under the the market-based payment approach. 

Why Should You Attend:

This webinar details the methodology and related requirements adopted by CMS for developing and finalizing a revised Medicare Clinical Laboratory Fee Schedule (CLFS) using rates paid by private health insurance companies, Medicaid Man-aged Care Organizations and Medicare Advantage plans. Key changes covered include the market-based data approach that Medicare used in setting payment rates taking effect Jan. 1, 2018; the switch over 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), the different pricing methods and reporting periods for existing and new ADLTs and final 2018 payment rate determinations made by CMS.

An analysis will be presented of lab pricing changes under the Medicare market-based system beginning 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 final 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 re-vised Medicare payment scheme
  • Learn about the latest guidance relating to Advanced Diagnostic Laboratory Tests (ADLTs)
Areas Covered in the Webinar:

  • Overview of Medicare’s new lab payment system required by PAMA
  • CMS regulatory timetable
  • Which tests are seeing the biggest cuts under PAMA
  • Identify test categories that will see higher payments
  • 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 will result in higher reductions for all labs
  • How new market-based rates are calculated
  • Which private payers are included in market-data approach
  • Phase-in of future payment reductions
  • 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
  • Key OIG findings relating to PAMA implementation by CMS
  • Why PAMA’s market scheme may impact private payer rates
  • Top remaining PAMA problems and concerns including 
  • Industry strategies to combat PAMA payment changes
Who Will Benefit:

  • Laboratory executives in independent & hospital settings 
  • President, CEOs, COOs & CIOs
  • Physicians & office managers responsible for in-office labs 
  • Medical & Administrative Director
  • Laboratory Managers
  • Head of Reimbursement
  • Billing and Finance 
  • Legal & Compliance Executives
Instructor Profile:

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 re-ports 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)

Available Options

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