PAMA Reporting Delayed Another Year as a Permanent Fix is Found

Good news for labs this month! The potential cuts to Clinical Lab Fee Schedule (CLFS) and changes in test reimbursement due to the Protecting Access to Medicare Act (PAMA) have been delayed until 2025. This is the fifth time Congress has stepped in to postpone these measures, providing labs with temporary relief through a short-term government funding bill.

What does this mean for your lab?

Without this last-minute intervention, many CLFS tests would have seen reductions of up to 15% in January, and labs would have been required to report new private payer data. If the reporting requirements outlined in the act are reinstated later, labs will need to submit data collected between January and June 2019.

PAMA Under-sampling issues

In 2014, Congress introduced PAMA to revamp CLFS into a single national fee schedule based on private market data from various laboratories serving Medicare beneficiaries. This includes independent laboratories, hospital outreach laboratories, and physician office laboratories (POLs).

However, the initial data collection in 2017 fell short, missing crucial information from hospital outreach laboratories and under-sampling POLs. The under-sampling resulted in nearly $4 billion in cuts to labs providing commonly ordered test services for Medicare beneficiaries. To put this in perspective, the total CLFS spend for 2020 was only $8 billion, less than 3% of Medicare Part B spending.

What happens next?

While we celebrate this temporary win, the industry needs to focus on passing the Saving Access to Lab Services Act (SALSA) in 2024. SALSA aims to implement a sustainable fix to the issues introduced by PAMA. A big thank you to the American Clinical Laboratory Association, National Independent Laboratory Association, and all lab advocates who played a role in making this change happen!

If you need assistance in keeping your lab compliant, contact our laboratory consultants today.