Photo: Rep. Boucher at Highlands Pathology Consultants for Lab Tour
For more information on how you can host your Senator or Representative on a laboratory tour, contact Chris Sherin either by phone, 202-354-7129, or email.
Ohio Governor Signs Direct Billing Legislation Into Law
Direct billing legislation was signed into law by Ohio Governor Ted Strickland Jan. 6, protecting patients in the state by prohibiting markups on certain anatomic pathology services by an ordering physician who does not perform or supervise the service.
House Bill 493, passed overwhelmingly in the House and unanimously in the Senate as S.B. 301, requires billing to be sent directly from the laboratory or physician performing or supervising anatomic pathology services to the patient or insurer.
After negotiations with legislators and other medical groups, an exemption was included in the legislation allowing a physician to bill for anatomic pathology services performed on a dermatology specimen if the billing physician discloses the name of the laboratory used, and the amount charged for the service by that laboratory.
Direct Billing has been a requirement of Medicare since 1984, and is consistent with American Medical Association ethics principles. Ohio is the 15th state to pass a Direct Billing law for certain anatomic pathology services.
The Ohio Society of Pathologists, in partnership with the College, strongly advocated for the passage of the legislation, which can be viewed on the Ohio Legislature’s Web site with members of OSP testifying on it’s behalf in both Senate and House committee hearings.
CMS Releases Final Clinical Lab Fee Schedule Including
CAP Recommendations
The Centers for Medicare and Medicaid Services released their final determinations for the 2009 Clinical Laboratory Fee Schedule Dec. 18, including recommendations by the College to crosswalk new CPT code 83951 to code 83950.
CMS reversed a preliminary decision and decided to accept the payment recommendation
after the College submitted comments in October—the final determinations are now the same or higher than what the College proposed
in formal comments at CMS’ Annual Clinical Laboratory Public Meeting in
Baltimore on July 14.
As previously reported in Statline, despite the pathology and laboratory communities’ unanimous support for crosswalking the new code 83951 Oncoprotein; des-gamma-carboxy-prothrombin (DCP) to code 83950 Oncoprotein; her-2/neu, this invaluable multi-stakeholder input was not initially used in CMS’ preliminary payment determination.
CAP Addresses Anti-Markup Issues in Final 2009 Physician
Fee Schedule
The College released comments to the Centers for Medicare and Medicaid Services Dec. 29 addressing anti-markup and physician self-referral issues in the final 2009 Physician Fee Schedule, outlining recommendations for future action on the In-office Ancillary Services Exception, Direct Billing and other key issues.
In the comments the College makes a number of recommendations for future changes to the reassignment and physician self-referral rules related to diagnostic tests, including the tightening of the supervision requirement for the TC, and the prohibition of “shared space” diagnostic services that occur in the same building.
CMS released the final 2009 PFS in October 2008—while it contained an extension for the technical component “grandfather” and the Physician Quality Reporting Initiative, and updates to the clinical lab fee schedule and the conversion factor, it did not include the College’s recommendations for an exception to the anti-markup provision applicable to pathology practices or independent laboratories.
Also included in the comments are the recommendations for CMS to consider anatomic pathology services as not part of in-office ancillary services.
For the complete comments, please visit the CAP Advocacy Web site under “Letters to Policymakers.”
United Healthcare Issues Final Ruling on Special Stain Codes
United Healthcare announced that they will now pay special stain codes 88312-88314 directly, without a primary procedure, when reported on the same date of service by the same provider for the same enrollee, following recommendations from the College.
In communication with the College, United Healthcare stated the rational for the decision includes:
- CAP’s current solicitation of the American Medical Association to remove the add-on classification from special stain add-on codes +88312-88314
- Current add-on codes are limited to the same date of service as the primary procedure. There are instances where the pathologists may have a specimen and weeks or months later the physician may request to run a special stain
- Special stains are performed for various reasons and the primary codes change frequently
The College applauds the decision, and looks forward to continuing to build partnerships and increase involvement within the private health insurance industry in order to shape positive health payment policies for pathologists.
Presentations from CAP Audio Conference on 2009 PQRI
Now Available
Presentations from the CAP audio conference held Dec. 17 on the Physician Quality Reporting Initiative, with updates for 2009, and real-life case studies, are now available on the Advocacy Web site.
The presentations, found under the Audio Conferences section, include important information from:
- Dr. David Witte, FCAP, on the background on the development of pathology measures.
- Dr. Jonathan Myles, FCAP, on specific PQRI examples.
- Sylvia Publ, MBA, RHIA, of the Centers for Medicare and Medicaid Services on Value-Based Purchasing, and the implementation of codes and measures.
If you have difficulty downloading any of the materials, please contact
Justin Herman.
CMS Releases Detailed 2009 PQRI Specifications Followed by Audio Conference
The Centers for Medicare and Medicaid Services has released detailed specifications for the 2009 Physician Quality Reporting Initiative measures and groups, and will hold an audio conference to discuss the program.
The first in a series of National Provider Calls for the 2009 PQRI will be held on Jan. 14—participants may register online.
Additionally, resources made available online by CMS include:
- Specifications Manual and Release Notes
- Implementation Guide
- Group Specifications Manual and Release Notes
- Getting Started with 2009 PQRI Reporting of Measures Groups
To access the resources, located on the PQRI page of the CMS Web site, continue to the Measure/Codes page, scroll down to the “Downloads” section and click on the appropriate link.
CAP Announces Update for Position on Licensure of Clinical
Lab Personnel
The College of American Pathologists announced Dec. 17 that it has revised its position on state legislation requiring licensure for clinical laboratory personnel, and outlined model criteria that will guide its decisions on whether to support or oppose licensure legislation introduced in the states.
For more information on the position, please visit the Advocacy Web site.
Congressional Laboratory Tours
CAP members hosted two lab tours recently, giving their Congressional representatives the opportunity to see first hand the role of pathology in patient care and discuss key issues like CAP’s position on Cytology PT and healthcare reform:
- Allison Hunt, MD, FCAP, and Carole Boudreaux, MD, FCAP, hosted Rep. Jo Bonner (R-AL) Dec. 12 for a tour of the University of South Alabama Medical Center in Mobile, Ala.
- Theresa Emory, MD, FCAP, hosted Rep. Rick Boucher (D-VA) Dec. 19 for a tour of Highlands Pathology Consultants, PC in Bristol Tenn. – along the Virginia border. Congressman Boucher is a member of the Energy and Commerce Committee.
For more information on how you can host your Senator or Representative on a laboratory tour, contact Chris Sherin either by phone, 202-354-7129, or email.
(For Statline reprint permission, please contact Justin Herman.)
STATLINE Archive
Contact: statline@cap.org
202-354-7100 • 202-354-7155 (fax) • 800-392-9994 |
Related Links
