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CMS PAMA

Kathy Posted Wed 11th of November, 2015 09:36:03 AM

Our lab sells CT/NG's and trich services to our local hospital (we are an independent lab. The Hospital bills the insurance companies.Since CMS will require us to report our private insurance payment amount do we need to report our reimbursement from the Hospital? They are not an insurance company? thanks, -kathy

SuperCoder Answered Thu 12th of November, 2015 06:48:49 AM

Please can you elaborate your question?

Thanks

Kathy Posted Fri 13th of November, 2015 16:11:08 PM

I am not sure I understand your confusion. Are you familiar with PAMA? As a independent lab we are required effective 1/1/2016 to report our private payer rates to CMS if we receive than $50,000.00 in revenue from medicare per year. We sell CT/NG's to a local Hospital and receive income from the Hospital, but the Hospital bills the insurance companies for these test not us. Our payment is a set fee per test. Do we need to report this hospital income to CMS for these test?

SuperCoder Answered Mon 16th of November, 2015 01:51:20 AM

Hi,

I think hospital is not an insurance company so you cant report to CMS your reimbursement from hospital. Hospital is billing the insurance company for your services. You act as a third party vendor to supply your services to hospital. I think you don't need to report your hospital income to CMS for these test.

Thanks

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