This page and related links last reviewed on August 20, 2012
Council on Government and Professional Affairs
Charge: To assist pathologists as they exercise their medical expertise and judgment in the best interest of the patient by promoting and developing payment policies that allow the provision of high quality pathology services; and to facilitate pathologists’ understanding of the payment policies and requirements of the government and other payers.
Number of face-to-face meetings: 3
Length of each meeting: 1.5 days
Typical meeting days of the week: Saturday/Half of Sunday
Location of meetings: Two meetings per year are in Washington DC; one is in another location
Number of conference calls: 2-12 per
year depending on workgroup assignment.
Hours of committee work required outside of
Member: 2–4 hours per month minimum
Vice Chair: 2–4 hours per month minimum
Chair and Workgroup Leads: 4–8 hours per month minimum
The Committee’s four Workgroup chairs and Committee leadership constitute the Economic Affairs Committee’s Executive Committee, for a one hour weekly conference call.
Additional travel or time commitments:
Vice Chairs and advisors may also serve as CAP liaison to AMA CPT and RUC requiring travel 1 to 3 times per year as well as representing CAP at meetings with agency officials as necessary
- CPT Coding Tutorial: The EAC is responsible
for maintaining the CPT Tutorial, a web-based course which consists
of fifteen coding vignettes and corresponding questions on a quarterly
bases. The vignettes consist of multiple-choice answers, identification
of and the rationale for the correct answer.
- CPT Coding Roundtables: The EAC provides
CPT coding roundtables at the CAP annual meeting.
- Pathology Measure Webinars: The EAC provides webinars for the membership when there are significant changes in pathology performance measures and/or in pay-for-performance and related programs.
- Medicare Local Coverage Decisions (LCDs): The EAC advocates for fair reimbursement policies at the Medicare local level by reviewing and commenting on LCDs and policy changes before they are implemented.
- Medicare Clinical Laboratory Fee Schedule Comments: The EAC reviews and prepares recommendations for suggested payment levels for new clinical laboratory test codes each year. The CAP recommendations are presented by an EAC member at Medicare’s annual Clinical Laboratory Fee Schedule public meeting.
- Medicare Physician Fee Schedule Comments: The EAC reviews and provides recommendations for public comments on each proposed and final Medicare Physician Fee Schedule published annually.
- Relative Value Recommendations: The EAC and its CPT-RUC workgroup conducts physician RBRVS surveys and makes recommendations for work relative value units and practice expense inputs for new and existing physician fee schedule codes to the AMA RUC. The EAC also reviews recommendations for the refinement of existing pathology services.
- Quality Measures: The EAC develops, maintains and manages the endorsement process of pathology-specific quality measures used by Medicare and other public and private payers in pay-for-reporting and value-based purchasing programs.
- Legal/Compliance Matters: The EAC advocates for members on issues that arise under federal self-referral, anti-kickback, privacy and other applicable laws and regulations.
- Private Sector: The EAC works to establish relationships in the private sector particularly with health plans to educate and achieve the most favorable treatment for pathologists on coverage and other policies and issues.
- National Correct Coding Initiative: The EAC CPT-RUC workgroup reviews proposed and implemented National Correct Coding Initiative (NCCI) edits and recommends advocacy efforts when appropriate. Recommendations include preparing response letters and coding proposals.
- New and Revised CPT Codes: The EAC CPT-RUC workgroup reviews recommendations for new or revised CPT codes and prepares and submits code change proposals when appropriate.
- Pathology Coding Caucus: The EAC oversees CAP participation in the Pathology Coding Caucus (PCC). CAP Chairs and coordinates PCC recommendations to CPT.
- Physician Quality Reporting System (PQRS): The EAC Measures and Performance Assessment Workgroup reviews existing and potential new measures for the PQRS program and recommends potential changes. This work includes evaluating the evidence base for candidate measures and any changes in the evidence base for existing measures as well as coding for measures and supporting the measure’s endorsement before the National Quality Forum (NQF).
- Value-Based Purchasing: The EAC Measures & Performance Assessment Workgroup reviews existing and proposed regulatory schemes to judge the value of physician services’ for their appropriateness for pathology.
- Interest or knowledge in pathology and laboratory CPT coding and payment systems; pathology-specific pathology metrics.
- The opportunity to contribute to CAP payment policy, represent CAP to agency and liaison organizations, and participate in presentations at educational conferences.
Representation on committee beyond the CAP:
- CAP representative to AMA RUC, CAP alternate member to AMA RUC, CAP advisor to AMA RUC, CAP advisor to AMA CPT, CAP representative to AMA CPT’s Pathology Coding Caucus and representative and alternate representative to the AMA’s Physician Consortium for Performance Improvement (PCPI).