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.

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