Advocacy Update

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The CAP has urged Congress to provide further financial and economic assistance to pathology practices as a result of the COVID-19 pandemic and economic downturn. With laboratories bringing new tests online to diagnose the novel coronavirus, testing volumes under normal conditions for blood and biopsy specimens have dropped significantly in recent weeks. The CAP wrote congressional leaders on April 14 with the concerns expressed by its members and outlined actions lawmakers can take to provide pathologists with the economic relief needed for their practices and laboratories.

The CAP’s letter complemented a similar request from the American Medical Association (AMA), which was sent to Congress on April 15. The CAP and AMA letters were in lockstep with each other by seeking to protect patient access to medical services by preserving the viability of physician practices. New provisions could become law as Congress debates enacting a “phase four” coronavirus relief bill to confront the national emergency of today.

Specifically, the CAP asked Congress to:

  • Mitigate the Centers for Medicare & Medicaid Services (CMS) -8% payment cut to pathology services in 2021. Congress can stop this cut by waiving budget neutrality for Medicare changes to evaluation and management (E/M) services that will be implemented on January 1, 2021.
  • Increase funding for the Paycheck Protection Program and ensure adequate financial support for physicians and their practices.
  • Support residents and medical students by providing at least $20,000 of federal student loan forgiveness or $20,000 of tuition relief.
  • Adjust repayment provisions for the Medicare Accelerated and Advanced Payment program, including increasing the time to repay loans and reducing an interest rate.

CAP Urges Pathologists to Apply for Financial Assistance

On April 8, CAP President Patrick Godbey, MD, FCAP, issued a statement in support of an effort in the Senate “to increase the Paycheck Protection Program to ensure small businesses, including pathology practices and laboratories, can financially survive this unprecedented national emergency.” Dr. Godbey asked that Congressional leaders to come together immediately on final legislation as health care professionals, including pathologists, are working to provide necessary tests for patients while losing revenue and incurring significant expenses related to the COVID-19 pandemic.

On April 7, the AMA, the CAP, and several other medical societies also requested immediate financial assistance for physicians across the country who diagnose and treat patients with the novel coronavirus. Specifically, in a letter from the AMA, physicians urged the Department of Health and Human Services (HHS) to provide one month of revenue to each physician, and other health professionals enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses.

The CMS delivered more than $51 billion in Medicare advanced payments to the health care providers on the frontlines battling COVID-19. The funds are provided through the expansion of the Accelerated and Advance Payment Program to ensure that providers and suppliers have the resources needed to combat the pandemic.

CMS Administrator Seema Verma noted that the CMS received over 32,000 requests. The CMS payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment suppliers.

In response to the COVID-19 pandemic, the CMS will provide accelerated payments to requesting providers and advance payments to requesting suppliers, including physicians and non-physician practitioners, who submit a request to the appropriate Medicare Administrative Contractor (MAC) and meet the following criteria:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form
  • Is not in bankruptcy
  • Not be under active medical review or program integrity investigation
  • Does not have any outstanding delinquent Medicare overpayments

Importantly, the advance and accelerated payments are a loan that providers must payback. The CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement. If the entire advance payment amount is not recouped within 210 days, CMS is required to charge interest on the difference between the amount recouped and the total advance payment amount. Sen. Jeanne Shaheen (D-NH) and other senators in a letter to HHS Secretary Azar and Administrator Verma called on the CMS to waive or modify the interest rates due to the unprecedented nature of this crisis and the financial stress to health care providers.

For questions on how to submit a request, the CMS has a fact sheet on the accelerated/advance payment process.

The CMS issued guidance to ensure coverage of COVID-19 diagnostic testing, including antibody testing, at no cost for those with private health insurance. Additionally, the AMA approved and revised COVID-19 CPT codes with critical input from the Pathology Coding Caucus, which is an advisory group to AMA CPT chaired by Ronald McLawhon, MD, FCAP. The AMA new COVID-19 CPT codes provide laboratories a more specific reporting mechanism for antibody tests for severe acute respiratory syndrome coronavirus 2.

The CMS required private health plans to cover both diagnostic testing for COVID-19 and certain related services provided during a medical visit with no cost-sharing. The CMS coverage requirement for private health plans includes urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for a COVID-19 test. Covered COVID-19 tests include all FDA-authorized COVID-19 diagnostic tests, COVID-19 diagnostic tests that developers request authorization for on an emergency basis, and COVID-19 diagnostic tests developed in and authorized by states. It also ensures that COVID-19 antibody testing will also be covered.

The CAP has signed on to support a public awareness and education campaign for COVID-19 convalescent plasma treatments. The US Food and Drug Administration (FDA) has authorized the use of COVID-19 convalescent plasma as a new treatment for those suffering from this virus.

AABB-accredited blood donation centers are authorized by the FDA to collect COVID-19 convalescent plasma, and the organizations like the AABB and CAP are assisting in getting the word out to patients who have recovered from COVID-19 to encourage them to schedule a donation.

As part of that effort, AABB launched a new website——to raise greater awareness about this important development. The website contains background information, FAQs, and our donor locator center—which is the only public directory of all blood collector locations in the United States. The CAP agreed to support this campaign on April 10.

Funds Available to Pathologists in the Wake of COVID-19

On April 10, the Department of Health and Human Services (HHS) initiated delivery of $30 billion in relief funding to providers as part of the funds included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act included a total of $100 billion to support health care providers through the Public Health and Social Services Emergency Fund (PHSSEF), and the CAP, together with the AMA urged the HHS to give funds directly to providers during the National Emergency.

The $30 billion distributed by the HHS will be based on the facility/provider share of the 2019 Medicare fee-for-service reimbursements with payments arriving via direct deposit. As emphasized by the HHS, these “are payments, not loans, to health care providers, and will not need to be repaid.”

Specifically, providers will be paid via Automated Clearing House information on file with UnitedHealth Group, UnitedHealthcare, or Optum Bank, or used for reimbursements from the CMS. Providers who usually receive a paper check for reimbursement from the CMS will receive a paper check in the mail for this payment as well. Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment.

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