College of American Pathologists
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December 23, 2009  •  Volume 25, Number 26
Next Issue: January 7, 2010
© 2009 College of American Pathologists

In This Issue:

Senate Expected to Pass Healthcare Bill on Christmas Eve
CMS Will Hold Claims for First Ten Days in 2010

Senate Expected to Pass Healthcare Bill on Christmas Eve

It's been more than a year since the Senate launched the first discussions to change the healthcare system with Finance Committee Chair Max Baucus's "Roadmap for Healthcare Reform" , but the day is finally upon us and the Senate appears just hours away from passing historic healthcare reform legislation, H.R. 3590, the “Patient Protection and Affordable Care Act”.

After the procedural votes today, the Senate is expected to vote on passage of the bill at 8 a.m. on December 24th. The procedural votes will require Democrats to win the backing of 60 members in order to break any GOP filibuster. Final passage of the measure, by contrast, will require a simple majority of 51 votes.

Earlier this week, Senate Majority Leader Harry Reid (D-NV) introduced his "manager's amendment" to the bill, including a number of key provisions for physicians. These are:

  • The 10% payment bonus for primary care and some general surgery services will NOT be offset by cuts in other physician services to maintain budget neutrality.
  • The proposed enrollment fee for physicians who participate in Medicare and Medicaid has been eliminated.
  • The proposed 1-year .5% increase in the physician payment conversion factor, designed as a short-term fix to the SGR, has been eliminated.
  • (Late last week the Senate passed a separate provision extending the 2009 conversion factor for 60 days beyond the January 1, 2010 reset date, a move designed to give Senators more time to propose a permanent replacement to the formula.)

CAP has been actively advocating for these and other provisions, as outlined in CAP's letter to the Senate, sent earlier this week. Highlights of that letter include:

  • Support for a diagnostic testing demonstration project to determine the value of pathologist-initiated consultations with patients and clinicians.
  • Opposition to a provision that would hamper innovation and competition in the growing field of personalized medicine by permitting only a select group of commercial laboratories to bill Medicare directly for particular tests.
  • Opposition to granting authority to an Independent Medicare Advisory Board that would shift responsibility for Medicare coverage and payment decisions to an unelected body in the Executive Branch.
  • Support for the bill's one-year extension of the Technical Component (TC) Grandfather for anatomic pathology services.
  • Urging allowance for other meaningful alternatives to measuring value under the Physician Quality Reporting Initiative.
  • Urging eligibility of all pathologists, including those whose practices are located in hospitals, to receive funding to modernize laboratory information systems and incorporate the connectivity software essential to coordinating care with primary care and other clinicians both in and outside the hospital setting.

If this bill passes in the Senate, it will next go to the Conference Committee where it will be merged with the healthcare reform bill passed in the House. If members of the House and the Senate approve the merged bill, it will then go to the President to be signed into law.

Comment On This Article

CMS Will Hold Claims for First Ten Days in 2010

In anticipation of further action on the SGR, the Centers for Medicare and Medicaid Services (CMS) sent a letter to Medicare physicians with information regarding holding claims for services paid under the 2010 Medicare Physician Fee Schedule.

CMS has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of January (January 1 - 15) for 2010 dates of services. After 10 business days, contractors will begin releasing held claims into processing under the fee schedule that implements current law. To avoid reprocessing claims, CMS wrote that it might be easiest for providers to hold claims in-house until it becomes clearer whether the new legislation will be enacted or until cash flow becomes problematic.


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