Photo: Rep. Erik Paulsen Tours Mercy Hospital of Coon Rapids, MN
CMS to Suspend Phase VIII of MUEs Until Workgroup Addresses Pathologists’ Concerns
The Centers for Medicare and Medicaid Services agreed to temporarily suspend Phase VIII of the Medically Unlikely Edits in late March after representatives from the College and the American Clinical Laboratory Association voiced concern over the latest round, which went into effect January 1.
A disproportionably high number of claim rejections from several of the newly established edits for large, specialized laboratories were reported during a recent meeting with CMS and the two groups.
CMS agreed to the suspension until a meeting could be held with those on the call as well as the MUE contractor, CMS medical officers and carrier medical directors to examine the MUEs—which may not be set at a medically correct number.
“The College has been calling for the establishment of an MUE working group for the past two years, emphasizing to CMS the uniqueness of pathology and laboratory codes,” said Stephen Black-Schaffer, MD FCAP, of the CAP Economic Affairs Committee. “We welcome this opportunity to engage with all key decision makers in the MUE process to address the concerns of pathologists.”
The suspension of this round of edits may take at least a week to implement, according to CMS, with a statement confirming the action soon to be released. Any decision to alter or reinstate the edits will be made after a meeting with the agency scheduled for later this month.
FTC Regulation of Physicians as Creditors to Take Effect
The Federal Trade Commission will include physicians in its definition of “creditors” starting May 1, 2009—a move that will require many physician practices to implement written identity theft prevention and detection programs in order to be in compliance.
Guidance material to help physicians comply with Federal Trade Commission Red Flag rule has been released by the American Medical Association, as the College and AMA continue to object to the agency’s designation and regulation of physicians as ‘creditors.’
In November 2007, the FTC issued a set of regulations, known as the Red Flags rule, requiring that certain entities develop and implement written identity theft prevention and detection programs to protect consumers from identity theft.
CAP and AMA expressed concern, and successfully delayed implementation of the rule until May 1, 2009. The College continues to advocate that physicians are not creditors, and should not be subject to the Red Flags rule.
While these efforts continue, AMA has prepared a guidance document, along with sample policies, so that members can incorporate a simple identity theft prevention and detection program into their existing compliance and HIPAA security and privacy policies.
To access the guidance material visit the AMA website, and for more information
from the Federal Trade Commission visit their Red Flags Rule website.
Pathologists’ Role Emphasized by CAP in Comparative Effectiveness Research Discussions
The central role that laboratory testing and diagnostics plays in minimizing the burden of disease, enhancing patient safety, and promoting patient-centered and personalized care must be recognized in Comparative Effectiveness Research development, according to CAP testimony provided to a federal council April 14.
The comments, delivered to the Federal Coordinating Council on Comparative Effectiveness Research by David Witte, MD, PhD, FCAP, also provided guidelines emphasizing that any organization established to evaluate clinical effectiveness be transparent and properly represent pathologists.
“The goal of the health care system should be to provide accessible quality health care to patients. This requires getting the right test, to the right patient, in the right time, to provide the right care,” said Dr. Witte, chair of the CAP Patient Safety and Performance Measures Committee.
The guidelines for CER development proposed in the CAP’s comments include:
- Any organizational entity that evaluates clinical effectiveness must be independent, objective, transparent and inclusive;
- Priorities should be based on consensus criteria derived from input provided by providers, patients, payers, purchasers and researchers;
- Pathologists and the pathology community should have substantial and central representation on the determining body because of their critical role in medical decisions.
The College also submitted a letter April 13 to the Institute of Medicine’s Committee on Effectiveness Research Priorities recommending that Committee recognize the central role that laboratory testing and diagnostics play in eliminating and minimizing the burden of disease, enhancing patient safety, and promoting patient-centered and personalized care. It additionally addresses which areas should have the highest priority for research funding allocated to the Secretary of Health and Human Services by the American Recovery and Investment Act of 2009.
IOM will submit a consensus report to Congress and HHS by June 30, 2009, that provides specific recommendations for the expenditure of more than $400 million in funds allocated in the economic stimulus package for Competitive Effectiveness Research.
To review CAP’s complete comments to the IOM, or the testimony to
the Federal Coordinating Council on Comparative Effectiveness Research,
visit the Advocacy website under Comments to Regulatory Agencies.
Congressional Lab 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:
- Mark Shertzer, MD, FCAP hosted Representative Bobby Bright (D- AL) at Pathology Laboratory Associates, South Alabama Medical Center Monday, April 6 in Dothan, AL.
- Joseph Goswitz, MD, FCAP hosted Representative Erik Paulsen (R-MN) at Mercy Hospital Tuesday, April 7 in Coon Rapids, MN.
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.
202-354-7100 • 202-354-7155 (fax) • 800-392-9994