Articles and Blogs

Under the Protecting Access to Medicare Act (“PAMA”), certain laboratories must report private payor data to the Centers for Medicare & Medicaid Services (“CMS”). This data is in turn used by CMS to establish a single, national Clinical Laboratory Fee Schedule. For a more detailed discussion on PAMA and the types of laboratories that... READ MORE

In 2014, Congress enacted the Protecting Access to Medicare Act (“PAMA”), changing the landscape of Medicare reimbursement for lab services. PAMA required the Centers for Medicare & Medicaid Services (“CMS”) to establish a single, national Clinical Laboratory Fee Schedule (“CLFS”) based on current charges in the private health care market. Below, we provide background... READ MORE

January 1, 2019 marked the start of a new data collection period for laboratories pursuant to the Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule (“CLFS Rule”).¹ The CLFS Rule establishes the Centers for Medicare & Medicaid Services’s (“CMS’s”) new private payor-based rate-setting system for clinical diagnostic laboratory tests (“CDLTs”) paid under the... READ MORE