Laboratory Question for the Week of July 8, 2019

Question:

What information is included in the private-payer claims data for (PAMA) reporting?

Answer:

The following applicable information should be part of the private-payer claims data under the Protecting Access to Medicare Act of 2014 (PAMA):

Laboratory tests subject to the data-collection and reporting requirements
Final amount paid by a private payer for laboratory tests after all private-payer price concessions are applied
Payments from secondary insurance payers
Any patient cost-sharing amounts, if applicable
Multiple payment rates for the same test.

This question was answered in an edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

Laboratory Question for the Week of July 8, 2019

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