2015 Medicare Fee Schedule Release Expected Soon
With the 2015 Medicare Physician Fee Schedule set for publication within the next several days, the CAP is preparing to provide members with information on new reimbursement changes and policy through STATLINE the day it is finalized and then give more in-depth analysis during a webinar presentation on November 5.
Registration is now open for members to reserve a spot for the webinar. The 90-minute CAP presentation begins at 1 pm EST on November 5. The CAP also will host a webinar on how to report 2015 Medicare Physician Quality Reporting System (PQRS) pathology measures on December 2.
Throughout the year, the CAP has advocated for favorable payment policies and mitigation of potential Medicare payment cuts in 2015. Most recently, the CAP opposed Medicare payment policy changes for prostate biopsy reimbursement. The CAP also has worked to address Medicare’s payment policy for immunohistochemistry services and encourage the adoption of three new Medicare PQRS measures for pathologists.
On July 3, the CMS proposed the Medicare fee schedule for 2015. The CMS is expected to finalize the 2015 regulation by October 31, 2014, or soon after. The CMS will publish their response to the CAP’s advocacy efforts to impact their proposed policies in this final rule.
The CAP has called on the CMS to abandon changes for reporting prostate biopsy services next year. For 2015, the Medicare agency proposed that pathologists use only one code (G0416) to report prostate biopsy services, regardless of the number of specimens. The CAP has urged the CMS to withdraw the proposal and use existing reporting mechanisms to accurately pay for the service.
The CMS may also alter other payment policies that affect pathologists. For 2014, the CMS changed how pathologists report immunohistochemistry services. The CAP advocated for an alternative to the CMS’ proposal and now awaits an agency decision.
Medicare payment changes are expected to in situ hybridization services after action was deferred on revaluation for 2014. The CMS identified these services as overvalued as part of its misvalued code initiative.
The CMS also proposed adding three new pathology measures created by the CAP to the 2015 PQRS program. Two of the pathology measures are related to lung cancer and the other is for melanoma. With the anticipated addition of the three measures, pathologists would have a total of eight PQRS measures in 2015. The CAP appreciates the CMS’ proposal and encourages the agency to finalize the new measures.
NY Should Remove Rule Stopping Pathologist-Patient Discussions
CAP President Gene N. Herbek, MD, FCAP, again urged New York state health officials to rescind a state regulation prohibiting pathologists from discussing laboratory test results with patients.
In response to a New York State Health Department request for information on models for interdisciplinary approach to health care involving pathologists, Dr. Herbek provided state officials with compelling evidence on the benefits of pathologist-patient conferrals in an October 21 letter. Further, more than 100 physicians in New York and 40 hospitals, laboratories, and medical academic institutions signed a statement supporting changing the state regulation.
“Please note these 108 New York physicians have affixed their signature to this document to make clear their strong personal conviction and support for the clinical position enunciated in the document,” Dr. Herbek wrote.
In February, the CAP called on New York State to repeal the regulation prohibiting pathologists from conferring with patients on their laboratory test result. Earlier that month the Department of Health and Human Services (HHS) granted greater patient access to laboratory results in a federal regulation. The HHS rule, which adopted several CAP recommendations, allows patients to request and receive test results from the laboratory. It also preempted state laws that impede patients directly receiving test results from the laboratory.
In response to a CAP request, the New York State Health Department had declined to repeal a regulation that prohibits patients from discussing with pathologists their test results. Health Department officials had requested clinical justification for rescinding the regulation.
Dr. Herbek provided articles, including peer-reviewed research, on how pathologists improve care through discussing test results with patients. However, in New York, the regulation poses fundamental challenges to these patient benefits and the practice of pathology medicine, Dr. Herbek wrote.
“[T]he College strongly believes that pathologists, as physicians, are, without question, medically trained and have requisite knowledge to advise their patients on the meaning or interpretation of pathology and laboratory tests,” Dr. Herbek said. “As was extensively documented in our prior correspondence, pathologists in New York are legally and ethically obligated to ensure their patients receive the information they need to understand their tests results.”
Watch for PathNET Alerts on State Advocacy Efforts
Engage in the CAP’s grassroots advocacy network on state-level issues important to pathologists through PathNET.
CAP members are already familiar with PathNET Action Alerts on federal issues. Thanks to grassroots advocacy efforts, the CAP has generated letters of support from Congress on recent issues such as CMS proposed payment cuts and electronic health record (EHR) meaningful use.
Members may not be aware, however, that PathNET also allows pathologists to easily engage with their state lawmakers. Several of the CAP’s key issues, such as direct billing of pathology services and accountable care organizations, will not be decided in Congress, but rather at the state level. Through PathNET, the CAP continues to mobilize pathologists on these ongoing initiatives. CAP has successfully secured favorable legislation in several states, but action is still required in others to protect patients and improve quality of care.
Be on the lookout for PathNET Action Alerts on pending state legislation in your state. More information on the PathNET grassroots network and important advocacy tools for CAP members is available online.
Comment on Changes to AMA Ethics Code
The latest draft of the American Medical Association (AMA) Code of Medical Ethics is now available for review and comment by AMA members.
The AMA Council on Ethical and Judicial Affairs (CEJA), which is modernizing the code of ethics, has posted its proposed revisions to the ethics code on the AMA website for general comments. The CAP has reviewed the draft, which now moves closer to addressing the CAP’s concerns. The revisions reflect some of the changes requested by the College, but the CAP will suggest further improvements to strengthen the code of ethics.
In June, the CAP had opposed initial changes that would have weakened the code. CAP President Gene N. Herbek, MD, FCAP, further stated the CAP’s concerns in a June 16 letter to the CEJA and recommended changes. The sections of the code of ethics in question involve consultation, referral, and second opinions; fees for medical services; and fees for nonclinical and administrative services. Changes had gone beyond modernization and deleteriously weakened the code, the CAP said.
The CAP will continue to engage with the AMA on proposed revisions to the code of ethics.
The College will keep members updated in STATLINE with the latest news as information becomes available.
Pathologists Must Be Exempt from EHR Medicare Penalty, AMA Says
In support of CAP advocacy to prevent Medicare penalties tied to meaningful use of EHRs, the AMA called on the CMS to extend a hardship exemption to pathologists and other specialties because meeting EHR requirements is not generally possible.
The AMA sent an October 14 letter calling for the continuation of the hardship exemption for pathologists to the CMS and Office of the National Coordinator for Health Information Technology (ONC). The 31-page letter also addressed physician adoption of health information technology, EHR system costs, and program criteria for demonstrating meaningful use (MU) of an EHR and offers a “blueprint” for improving the program. The AMA stated that specialists like pathologists face high barriers to meeting MU standards.
“Meeting the MU requirements is not always possible for these specialists, it is unduly burdensome given the current state of commercially available EHRs, particularly with respect to standalone specialty system products, certification of technology appropriate for these specialties, workflow challenges, nature of the patient relationship, and patient data needs,” the AMA stated.
The CAP has worked with the CMS to exempt pathologists from the MU penalty in 2015, but the Medicare agency has not indicated if it will extend the exception to pathologists in subsequent years when the penalty stands to lower Medicare Part B payments by 2% in 2016 and 3% in 2017. Further, the CMS has stated that pathologists and other physicians should not expect relief from future penalties.
On Capitol Hill, more than 100 lawmakers in the House and Senate have written the CMS to ask the agency to exempt pathologists from MU penalties. Throughout 2014, CAP members participated in a vigorous grassroots campaign to encourage their representatives to prevent future penalties from hitting pathologists.
According to the government’s own data, as of June 2014, only 38 pathologists have attested to demonstrating MU in all three years of the program. Only 366 had attested at least once.
CMS Releases Preliminary 2015 CLFS Determinations
The CMS published its preliminary 2015 Medicare clinical laboratory fee schedule (CLFS) determinations with payment methodologies for new and revised codes for next year.
For the new Tier 1 Molecular Pathology and genomic sequencing procedures (GSP) AMA current procedural terminology (CPT) codes, the CMS plans to use the gap-fill methodology for 2015. The CMS states it also will use gap-fill methodology for the new multianalyte assays with algorithmic analysis (MAAA) codes when a Medicare contractor determines the service is payable.
The CAP had engaged with the CMS on CLFS payment changes and presented 2015 CLFS payment recommendations for the new and revised codes at the July 2014 public meeting. The College is reviewing the preliminary determinations and will continue to work with stakeholders and provide the Medicare agency with comments regarding the CLFS. Stakeholders are assessing next steps to support appropriate payment for these new CLFS services.
Per the CMS, the basis of payment and the amount of payment will become final at the same time that the CMS issues the annual instruction for 2015 in early November 2014. The public then has 60 days from the date the CMS issues the annual instruction to request reconsideration of either the basis of payment or the amount of payment for these new test codes. And, the public may comment on any reconsideration requests at the next annual public meeting.
In keeping with the process used in 2013 for the large group of Tier 1 Molecular Pathology CPT codes, for any new test code that will be gap-filled for 2015, the CMS will ask Medicare contractors to develop carrier-specific gap-filled amounts by April 1. These amounts will then be finalized on September 30 of that year. Unlike a crosswalk test, the payment amount for a gap-fill test is not established when the CMS determines the basis for payment because it takes approximately nine months for Medicare contractors to establish carrier-specific amounts.
Medicare Approves Coverage of Cologuard
The CMS will reimburse the stool DNA test Cologuard for colorectal cancer screening for Medicare patients, the agency announced in an October 9 national coverage decision memo.
After an analysis and public comment period, the CMS determined that the evidence was sufficient to cover the colorectal cancer screening test. Medicare Part B will cover the test once every three years for beneficiaries who meet all of the following criteria:
- Age 50 to 85 years,
- Asymptomatic, and
- At average risk of developing colorectal cancer
Screening with Cologuard as an adjunctive colon cancer screening tool has the potential to increase screening compliance and reduce the number of colon cancers to millions of Medicare beneficiaries.
Three Easy Ways to Renew Your CAP Membership
It’s time to renew your CAP membership; don’t miss out on the top resources for pathologists in 2015. There are three easy ways to renew.
- Pay Dues Online: Log in to cap.org/renew and select the Membership Dues & Contributions tab.
- Pay Dues by Phone: Call 800-323-4040, option 2 today.
- Watch Your Mail! You will soon receive a hard copy invoice in the mail which can be returned to the CAP.
202-354-7100 • 202-354-8101 (fax) • 800-392-9994