Tuesday, March 28, 2017

Brief Blog: ACLA asks CMS to Delay PAMA and Expand Hospital Lab Reporting Too

Last week, ACLA held its annual meeting in Washington.  ACLA has formally asked CMS to delay PAMA for a year - and not only delay it, but re-write the rules on the scope of labs which will be obligated to report.   A CMS administrator made comments suggesting that CMS was considering the possibility of a PAMA delay.

  • See open-access coverage at Dark Daily (here). 
  • See also a flurry of several press releases in recent days on the ACLA news website, here.
  • Subscription coverage at Genomeweb (here).

Senior CMS administrator Carol Blackford, head of all outpatient services for Medicare, spoke at the conference.  According to the news reports, Blackford publicly acknowledged some difficulties in computer processes supporting PAMA data submission, such as periods when the systems have been down.  Overall, data submission so far is less than anticipated by CMS.   The current deadline for data submission is Friday March 31, and failure to submit carries substantial penalties.

CMS Has Difficulty Handling 81162 Claims

Blackford's comments included the fact that "files were rejected based on a valid HCPCS code 81162."   81162 is one of several confusingly priced CPT codes related to BRCA testing (here).  

ADLT Instructions: In the Pipeline

Blackford also noted that while no instructions for applying for Advanced Diagnostic Laboratory Test (ADLT) codes have been provided, a submission form has been created by now, and is being reviewed by general counsel at CMS before release.  ADLT codes received privileged coding and pricing processes under PAMA.

OIG Reports from September 2016

Genomeweb's article pointed me to two September 2016 OIG reports that relate to PAMA changes; I had missed these.  OIG home page for the articles, here.   OIG issued one report (16-00040) on 2015 baseline CLFS payments, here, and a second report on "CMS Progress in Implementing PAMA (16-00100), here.   ReedSmith summarized the two OIG reports last October, here.