Lincoln, Nebraska – March 19, 2015 – The Protecting Access to Medicare Act of 2014 (PAMA) was signed into law on April 1, 2014 and lays the groundwork for a comprehensive reform of the Clinical Laboratory Fee Schedule (CLFS). The CLFS rates will be determined from private payer reimbursement rates paid to laboratories. There will also be an impact for certain codes in the Physician Fee Schedule. The Centers for Medicare and Medicaid Services (CMS) will make a final ruling on June 30, 2015 explaining how CMS will collect data and how it will be used to set new CLFS rates.

How This Will Affect Laboratories

For the most part, this will affect all clinical labs. There could be exceptions for low volume or low expenditure threshold that could exclude a lab from PAMA, but all labs should be prepared to provide the applicable data.

Laboratories will be tasked to provide information to CMS once the final ruling is made. PAMA has not yet identified exactly what information will be required or the format in which it will need to be supplied, but it will replace the methodology that has been used historically.

The TELCOR Solution

TELCOR RCM is already prepared to meet the requirements of PAMA, regardless of what the final ruling contains. TELCOR has always had the foresight to recognize that our customers need simplified access to their revenue cycle data for operational reasons. Therefore, TELCOR RCM maintains all the detail of each payer’s response. For each service line on a claim, this can include:

  • Allowed amounts
  • Payments
  • Adjustments
  • Remittance advice

To revolutionize laboratory’s access to this data, TELCOR RCM incorporates Decision Support analytics as part of the application. This allows our customer’s unparalleled access to revenue cycle details right now, in real-time, at any time the laboratory needs to respond to industry reporting requirements.

Our customers use analytics to determine if they are getting paid as expected from each payer, identifying trends in reimbursements and efficiently monitoring the effectiveness of their claim submission and appeal processes. In addition to easy access, all TELCOR RCM analytics can easily be exported to Excel.

Whether it’s PAMA or other yet unveiled requirements, TELCOR RCM customers have confidence their RCM solution best positions them to respond. After all, how can laboratories expect to adapt to the changing reimbursement landscapes without the ability to monitor and manage their business with robust data intelligence?

For more information, please contact Marketing Director Karis Ahlberg at 402-489-1207.

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TELCOR, celebrating its 20th year, is an industry leader in the laboratory revenue cycle management and laboratory point of care markets, providing unparalleled software products and services, and exceptional customer support. TELCOR’s proven implementations are performed by clinically experienced, IT knowledgeable resources who understand each customer’s unique environment.