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Xifin highlights flaws in CMS draft PAMA pricing

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Sept. 27, 2017Xifin has conducted an initial review of the draft laboratory rates published on Sept. 22 by the Centers for Medicare and Medicaid Services for 2018 clinical laboratory tests under the Protecting Access to Medicare Act.

Xifin’s preliminary analysis reveals fundamental concerns with the exercise that provides the basis for challenging the proposed schedule. Chief among the company’s concerns is that preliminary rate data is not market based and excludes rate information from the majority of acute care hospitals and community-based laboratories throughout the U.S.

“The preliminary rate calculations are flawed due to the way the exercise was designed, resulting in lack of true market and industry participation in the rate setting,” Lâle White, Xifin CEO, said in a company statement. “Only about 34 percent of the lab market is represented, with two major labs representing 80 percent of the volume used to calculate the rates.”

CMS is accepting comments until Oct. 23. Comments must be submitted electronically to the following CMS mailbox: CLFS_Annual_Public_Meeting@cms.hhs.gov.

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