Setting Medicare Payment Rates for Clinical Diagnostic Laboratory Tests: Strategies To Ensure Data Quality

The Protecting Access to Medicare Act of 2014 (PAMA) reformed the way the Medicare program sets payment rates for clinical diagnostic laboratory tests (lab tests) under Part B. CMS's new rates, which took effect on January 1, 2018, are based on lab-reported data: rates paid by private payers such as private health insurers, Medicaid managed care organizations, and Medicare Advantage plans. As part of the same legislation reforming Medicare's payment system, PAMA mandates that OIG conduct analyses it determines appropriate with respect to the implementation and effect of the new payment system. This review focuses on CMS's implementation activities in 2017 and the new payment rates that took effect on January 1, 2018.