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CAP Home > CAP Advocacy > Content for Medicare 2014 Physician Fee Schedule Resource Center

  Medicare 2014 Physician Fee Schedule Resource Center

 

Updated February 25, 2014

2014 Medicare Physician Fee Schedule Cuts Payment for Pathology TC and Global Payments

The Centers for Medicare and Medicaid Services released the final 2014 Physician Fee Schedule (PFS) Rule and the Hospital Outpatient Payment Rule. CAP has provided a list of frequently asked questions to offer additional information on the ruling.

CAP Provides Members with Resources on Coding Challenges

The College of American Pathologists is strongly committed to its role as the leader in pathology CPT coding advocacy. However, CAP is not able to respond to individual CPT billing questions as we cannot assume liability for a CAP member’s decision on interpretation of the Current Procedural Terminology (CPT) codes that are defined by the American Medical Association (AMA) or the G codes that are defined by the Centers for Medicare Services (CMS). To that end, we provide you with the following sources of original information.

CAP recommends that its members obtain a copy of the American Medical Association’s (AMA) CPT Professional Codebook if they do not already have one. The CPT® 2014 Professional Edition is the definitive AMA authored resource to help health care professionals correctly report and bill medical procedures and services. The AMA publishes the only CPT® codebook with the official CPT guidelines. Only the AMA, with the help of physicians and other experts in the health care community, creates and maintains the CPT code set. It is available for purchase at AMA 2014 CPT Codebook.

CAP also recommends that its members contact their individual carriers or payers on their specific payment policies.

CAP has arranged for members to receive a discount on subscriptions to a CPT coding service. Through the PathLab Coding Solutions service, subscribers receive timely written responses supported by authoritative documentation to their CPT questions. Non-CAP members may subscribe to the service at a non-discounted rate. A subscription is required to submit a question to PathLab Coding Solutions. More information on PathLab Coding Solutions is available after logging on to cap.org in the Coding and Payment section of cap.org/practicemanagement.

CAP members should also utilize the Centers for Medicare Services (CMS) as the official source on information on G code reporting (see pg. 74333).

The College also has compiled several resources on the Medicare physician fee schedule rule. Listen to CAP’s recent webinar to learn more about how the rule impacts you. A list of frequently asked questions also is available for download.

CAP Actions

CAP has been meeting with CMS and the White House to lay out our specific concerns. On September 6, CAP submitted formal comment letters to CMS:

CAP has also engaged with the AMA and other affected organizations to strengthen our response efforts. As the Congress considers legislation to repeal the Sustainable Growth Rate (SGR), CAP is engaged in finding alternative ways for pathologists to meet quality and pay for performance requirements.

CAP’s Position

  • CAP opposes this new round of cuts to pathologists and pathology practices.
  • CMS’ proposal to link payment for pathology services to rates paid in the hospital outpatient prospective payment system is particularly concerning.
  • The proposed policy fails to take into consideration the technical costs associated with specific individual codes.
  • Further, it fails to recognize the distinct costs of physician services, which are required by law to be based on the resources required to perform the service.
  • CAP supports the existing AMA-RUC process for valuing physician service codes. This process involves many stakeholders, including CAP.
  • The AMA-RUC has shown itself to be accurate and fair, and has been thoroughly vetted over many years.
  • CAP remains concerned about CMS’ implementation of the Physician Quality Reporting System. CAP proposed three new quality measures for pathologists, which CMS rejected.

Final Rule Impact Chart

The 2014_Physician Fee Schedule Final Rule Impact Table
(Excel, 176 KB)

Change in APC Payment Rates for Select Pathology Services
(PDF, 110 KB)

CAP Advocacy Resources

Federal Register Links

CAP News Coverage and Alerts on Final Rule

Webinars

View the CMS 2014 Physician Fee Schedule Webinar.

A recording of the Dec. 4 CMS Physician Fee Schedule webinar is now available online. The 90-minute webinar features CAP leaders explaining the changes announced by CMS regarding the final 2014 Physician Fee Schedule (PFS) rule released on Nov. 27, which contains reimbursement changes affecting pathologists. Learn about the final rule’s pathology-related details, the impact on pathologists and CAP’s advocacy efforts around these issues. The webinar also includes a Q & A with the CAP’s staff and members.

Podcasts

Confronting New Medicare Payment Realities: What CAP Members Need to Know about the 2014 Physician Quality Reporting System (PQRS)�, featuring Jonathan L. Myles, MD FCAP, Chair, CAP Economic Affairs Committee (EAC) Pathology Advisor, AMA RUC and Diana Cardona, MD FCAP, Chair, EAC Measures and Performance Assessment Sub-Committee. CAP members will learn about:

  • The 2013 PQRS still underway;
  • What’s New for PQRS in 2014; and
  • The Value-Based Modifier Program.
 
       
 
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