College of American Pathologists
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March 15, 2012  •  Volume 28, Number 6
Next Issue: March 29, 2012
© 2012 College of American Pathologists

2012 CAP Policy MeetingIn This Issue:

IPAB Repeal Bill Set for House Vote Next Week

House leaders are set to vote next week on a bill to repeal one of the most controversial aspects of the health care reform law, the Independent Payment Advisory Board (IPAB). The cost of the repeal, estimated at $3.1 billion over 10 years, will be paid for by including it in another bill aimed at reforming medical malpractice—H.R. 5.

Introduced by Rep. Phil Roe, MD (R-TN), The Medicare Decisions Accountability Act passed the House Energy and Commerce, as well as the Ways and Means committees in early March. The bill has 234 co-sponsors, including at least 20 Democrats. The full House is expected to vote on the bill soon after members return from this week’s recess.

Despite this momentum in the House, the Senate bill to repeal the IPAB (S.3653), introduced by Republicans John Cornyn (TX) and Orrin Hatch (UT), is unlikely to pass that Democrat-controlled chamber.

Drawing opposition from leading health care provider groups, including the AMA and the CAP, this provision would transfer responsibility for Medicare coverage and payment decisions from Congress to an unelected body in the Executive Branch. Furthermore, the CAP believes that the additional authority granted to the IPAB under the President’s 2011 deficit reduction proposal could exacerbate this already troubling approach to controlling the growth of Medicare spending.

CAP Requests CMS Delay, Clarify Point of Service Changes

The College is working with CMS to delay implementation of a recent agency transmittal that would significantly alter how pathologists code for point-of-service (POS), and create confusion for Medicare carriers on the technical component “grandfather” provision expiration date.

Transmittal 2407: Proposed Point-of-Service Code Changes, Effective
Apr. 1
  • The correct POS code assignment shall be for that setting in which the beneficiary is receiving inpatient (POS code 21) or outpatient care (POS code 22) from a hospital.
  • Pathologists who work from their office or laboratory and receive specimens from hospitals must use POS 21 or 22 ; claims will be denied if they use POS 11 (physician’s office) or 81 (independent lab).

CMS released Program Transmittal 2407 based on instructions from the Office of Inspector General (OIG), as the agency is concerned about the volume of physician/practitioner claims incorrectly reported as occurring in the office POS, when in fact, these services are provided in outpatient hospitals or ambulatory service centers (ASCs). These incorrectly coded claims are then paid by the CMS contractor at the non-facility rate, rather than the lower facility rate.

For pathologists, this means that as of Apr. 1, claims must include the correct POS code for where the pathologist performed the TC service (see box). Because the transmittal does not include clarifying instructions for pathologists or pathology services, claims using POS 11 (physician’s office) or 81 (independent lab) may be denied if the transmittal is left unrevised.

To minimize the impact on pathologists, the College has urged CMS to postpone implementation of these changes until at least July 1. The College is also recommending that clarifying edits be made in the Medicare Claims Processing Manual regarding instructions pertaining to pathology services, and that the instructions include pathology examples for clarification. The CAP is also recommending that pathologists be allowed to use the POS 11 code for procedures performed on archive specimens or on a confirmatory or secondary opinion consultation. Finally, contractors should be reminded that no professional or TC anatomic pathology service CPT code appears in the edit lists for bundled ASC services.

HIT Chief Mostashari Emphasizes Value of Meaningful Use in Test Ordering

Using certified meaningful use electronic health record systems (EHRs) is key to improving quality and reducing costs by preventing unnecessary treatments and services—including diagnostic testing, stated National Coordinator for Health Information Technology Farzad Mostashari, MD, in a recent government blog post. The Office of National Coordinator (ONC) head was responding to a recent Health Affairs study (PDF, 212 KB) that found physician access to computerized imaging results increased test ordering by 40%-70%.

The study’s findings, reported by the national media including the New York Times, raised critical questions about the multi-billion federal investment in HIT. In addition to looking at imaging, the study’s researchers also found that physician access to computerized laboratory test results was indeed associated with a greater likelihood of ordering blood tests, although they did not detail the data on these findings. These results led the research team, led by Danny McCormick, MD, of the Harvard Medical School, to conclude that the federal government’s efforts to promote HIT adoption may not result in savings from reducing duplicative diagnostic testing. “Indeed, it is possible that computerization will drive costs in this area up, not down,” the researchers concluded.

ONC Chief Questions Findings

These conclusions prompted a blistering response from Dr. Mostashari on Health IT Buzz, the ONC’s blog. He noted that not only were the findings based on an observational study, rather than a randomized trial, but did not analyze EHRs, rather just the electronic viewing of test results. The study also looked at data from 2008, prior to the passing of the HITECH Act linking payment incentives to meaningful use of EHRs.

Dr. Mostashari also criticized the study for not including clinical decision support tools that assist providers in test ordering and treatment decision making. “These are two of the most critical features of certified EHRs, which have been shown in multiple well-designed studies to reduce unnecessary and duplicative tests,” he noted.

He also noted the study failed to include other variables that could affect physician behavior, including the level of physician training. In addition, the researchers failed to examine financial arrangements related to testing capabilities. “The authors themselves correctly note that physicians who have a financial stake in imaging are more likely to purchase systems with image results capabilities, making self-referral a likely explanation for their results,” stated Dr. Mostashari.

A response by the study’s researchers to Dr. Mostashari’s criticisms can be found on the Health Affairs blog.

NIH Launches Genetic Test Registry

The National Institutes of Health’s long-awaited Genetic Testing Registry is now online. The registry is built using data voluntarily submitted by genetic test providers. Specifically, the registry includes the purpose of each genetic test and its limitations, the name and location of the test provider, and whether it is a clinical or research test. The registry also details what the test measures and test methods.

The agency developed the registry based on stakeholder input from genetic test developers, test kit manufacturers, health care providers, patients, and researchers. The College responded to NIH’s request for comments in November 2010 during the registry’s proposal phase.

Colorado Direct Billing Legislation Sent to Governor

Colorado Governor John Hickenlooper (D) is expected to sign into law legislation ensuring that patients are billed for anatomic pathology (AP) services only by the physician performing or supervising the service, in order to protect the patient from having a “mark-up charge” added by an ordering physician.

The College worked with the Colorado Society of Clinical Pathologists (CSCP) to pass this direct billing legislation (HB 1221) that unanimously passed the state’s House of Representatives by a vote of 62-0, as well as the Senate by a vote of 34-0. After the House concurred with the Senate on technical amendments on March 9, the bill was sent to the governor for his signature.

Once Gov. Hickenlooper signs the bill into law, Colorado will be the 19th state to pass a direct billing law for AP services. Currently, more than two-thirds of the U.S. population is direct billed for anatomic pathology services under federal and state law.

Maine Lawmakers Approve Reversal on Billing Disclosure, Specimen Transport Changes

Maine lawmakers have approved amendments halting significant changes to the state’s laboratory act related to billing disclosure and personnel allowed to collect and transmit laboratory specimens. Gov. Paul LePage (R) is expected to sign the bill into law.

The CAP, in collaboration with the Maine Pathology Society and the Maine Medical Association, worked to amend LD 1624, which initially repealed the state’s laboratory billing disclosure law requiring a copy of the itemized bill be sent to the patient. However, this amendment deletes this repeal.

The bill’s original language also removed the exemption allowing technical laboratory personnel to collect and transmit specimens under the direction or upon the request of a physician. The amended bill restores that exemption. .

Keep Up with the Latest CAP Advocacy News on Twitter

CAP Advocacy is now on Twitter. Follow CAP Advocacy’s daily “tweets” to keep pace with regulatory and legislative news affecting pathology. For the latest health care news, be sure to check out what we are following on Twitter.


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