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Monitoring Medicare Payments for Clinical Diagnostic Laboratory Tests - Mandatory Review

Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA) requires Centers for Medicare & Medicaid Services to replace its current system of determining payment rates for Medicare Part B clinical diagnostic laboratory tests with a new market-based system that will use rates paid to laboratories by private payers. Pursuant to PAMA, OIG is required to conduct an annual analysis of the top 25 laboratory tests by Medicare payments and analyze the implementation and effect of the new payment system. We will analyze Medicare payments for clinical diagnostic laboratory tests performed in 2016 and monitor Centers for Medicare & Medicaid Services's implementation of the new Medicare payment system for these tests. This work will build upon our previous analyses of Medicare Part B laboratory test payments in 2014 and 2015 and our review of Centers for Medicare & Medicaid Services's progress toward implementing the new Medicare payment system.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
October 2017 Centers for Medicare & Medicaid Services Monitoring Medicare Payments for Clinical Diagnostic Laboratory Tests � Mandatory Review Office of Evaluation and Inspections OEI-09-17-00050; OEI-09-17-00140 2017, 2018

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