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Lab Industry Says PAMA Reimbursement Rates Not Really Market-Based

 
• By Sue Darcey

The US Medicare agency was supposed to peg its Clinical Lab Fee Schedule reimbursement rates for 2018 to market-based prices supplied by labs under the 2014 Protecting Access to Medicare Act. The exercise might have increased payment rates for lab tests, but clinical labs say that the new Medicare rates actually make deep cuts that could disrupt access to laboratory services.

Draft reimbursement rates published under the Clinical Laboratory Fee Schedule (CLFS) Sept. 22 do not truly reflect market-based charges for laboratory tests, as promised under the Protecting Access to Medicare Act (PAMA), the American Clinical Laboratory Association argues.

"ACLA has conducted an initial review of the draft PAMA rates. With few exceptions, these rates are not market-based …...

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