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Topic starter
If your facility has a clinical laboratory, you may be required by CMS to report private payer information for the first 6 months of 2016. I am looking for a Centricity Report that will pull the necessary information from our claim data that is required by PAMA. Has anyone come up with such a report and is willing to share it? It requires Claim information for each approved amount from each payer by CPT code that includes the number of claims paid.
Thank you in advance for any guidance.
Karen
Posted : September 23, 2016 5:29 am
Karen,
Our practice has an internal lab and does enough volume that we will have to accommodate the PAMA requirements. This report shouldn't be difficult to pull together, but we have put this on the back burner for now. I'd be happy to share our solution later this year when we turn our attention to this reporting requirement. Feel free to shoot me an email in early November. I suspect we will be able to look at it then.
Posted : September 26, 2016 1:10 am
Topic starter
Thank you for your response. I know I am early but I would like to following up with you to see if you have made any progress on this report. I have a quote from VOW to build a report for $825. Since those of us who have an in office laboratory will likely need this report, I am hoping this price can be shared among those who will utilize it or that GE will see this as a need within our CHUG community and just build it for us.
Not holding my breath for either option. Before I shell out the $825, I thought I would reach out to you to see if you have made any progress.
Thanks,
Karen
Posted : October 17, 2016 5:53 am
Topic starter
According to the updated FAQ section on the CMS PAMA website, our POL will qualify as an applicable lab and will not be reporting. Thank you for your assistance.
Posted : November 3, 2016 3:41 am
Interesting. Can you post the link where you found that information? We just walked through the 4 tests published on CMS' website to determine applicability and it appears we will have to report. Perhaps you have discovered something that provides better clarification. Regardless, I have created the query to pull our test volume data from the database directly for the reporting period (Jan 1 - Jun 30, 2016). The next step was to connect those orders to the specific payors to get an overall idea of the distribution. That data along with the relevant HCSPCS codes (CPT codes) and payor fee schedules should comprise the data that is needed. I don't think I'll work on this anymore though until I get clarification on whether or not we need to report.
Posted : November 3, 2016 3:49 am
Topic starter
Here is the link...
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Downloads/CMS-1621-F-FAQ.pdf
Our lab bills under the provider group NPI for Medicare but have a unique NPI assigned to the lab so question 12 and 13 were most helpful for us. (see Below)
Q2.12. In order to qualify as an applicable laboratory, does a laboratory have to be assigned its own unique NPI number (that is, the NPI is assigned only to a given laboratory) which then bills for its laboratory services only under its unique laboratory NPI?
Updated 10/13/2016
A2.12. No, a laboratory could share an NPI with another laboratory or other supplier such as a physician’s office or group practice. That is, although a laboratory must have its own NPI, the group practice could also be assigned the same NPI as the laboratory. In other words, the laboratory’s NPI doesn’t have to be unique to the laboratory. If the laboratory and group practice are both assigned the same NPI and the group practice bills for its laboratory’s services, then in essence, the laboratory’s services are being billed under its own NPI. Example 4 from Medicare Learning Network article SE1619 is an example of a scenario wherein the laboratory and physician office are assigned the same NPI.
This example is provided below.
Example 4: An entity consists of five physician offices and one CLIA-certified laboratory. All five physician offices and the CLIA-certified laboratory are assigned the same NPI and bill for services under the same NPI. In this example, the majority of Medicare revenues threshold and low expenditure threshold are applied based on the combined revenues of all components of the entity that bill for services under the same NPI. In other words, since the physician offices and CLIA-certified laboratory all have the same NPI and bill Medicare Part B under the same NPI, the entity is considered a single laboratory for purposes of applying the majority of Medicare revenues threshold and low expenditure threshold.
Q2.13. Can a laboratory qualify as an applicable laboratory if the laboratory and group practice are assigned different NPIs?
A2.13. If the group practice is assigned a different NPI (different from its laboratory) and the group practice bills for its laboratory’s services under the group practice NPI, the laboratory’s services are not being billed under the laboratory’s own NPI. The laboratory does not qualify as an applicable laboratory if no services are billed to Medicare Part B under its own NPI because no revenues attributed to the NPI are assigned to the laboratory.
There was a Webinar yesterday that described the reporting process. You can find the presentation and supporting documentation at this website.
https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.html
Good Luck!
Posted : November 3, 2016 4:04 am
Thank you. This is helpful. We may be in the same boat as you guys...hoping.
Posted : November 3, 2016 4:32 am
