Read the Latest Issue of STATLINE
April 28, 2015
IHC, In Situ Hybridization, Prostate Biopsy Medicare Changes for 2015
In a new series of short videos for CAP members, the College reviewed Medicare reimbursement changes in the 2015 fee schedule and other advocacy issues affecting pathologists. The video briefings on Medicare changes to immunohistochemistry, in situ hybridization, and prostate biopsy services are now available to view on your computer, smartphone, or tablet device, and share with your colleagues.
CAP Economic Affairs Committee Chair Jonathan L. Myles, MD, FCAP presented the series on the 2015 Medicare Fee Schedule changes. To view a presentation and start viewing, select the topic by clicking a link below:
The videos play after entering your name and email address. CAP members are encouraged to share the link to this presentation with colleagues, administrators, and other interested stakeholders. In addition to viewing this on your computer, it can also be viewed on your smartphone or tablet by clicking the link to this presentation from your device.
If you have any questions please feel free to send an email to us. Watch for new briefings and more advocacy and policy news in our weekly STATLINE newsletter for CAP members.
Pathologists Granted Automatic Exemption to EHR Penalty in 2016
Pathologists will receive an automatic exemption from the 2016 Medicare electronic health record (EHR) penalty and will not be required to file a formal application, the Centers for Medicare & Medicaid Services (CMS) stated in instructions to physicians.
Working with Congress and the Medicare agency, the CAP has secured for pathologists full relief from Medicare penalties under the EHR meaningful use program in 2015 and 2016. Pathologists classified in Medicare's enrollment system as under the specialty "Pathology (22)" will be granted an automatic exemption from the 2016 payment adjustment, the CMS said.
The CMS detailed instructions for those eligible for the hardship exemption. Physicians without an automatic exemption but qualify for a hardship must file an application by July 1. Since pathologists receive an automatic exemption, they do not need to file the application.
In 2014, more than 100 federal lawmakers had urged the CMS to grant pathologists full relief from Medicare penalties under the program requiring physicians to demonstrate meaningful use of an EHR. The CAP facilitated meetings between pathologists and their representatives and senators, and encouraged them to sign on to letters to the agency. Many of the meaningful use program's requirements and measurements do not fit or apply to a pathologist’s scope of practice. Achieving meaningful use standards is very difficult, or impossible, for most pathologists.
DOJ: Practice Pays $3.2 Million Settlement for Alleged Self-Referrals
A dermatology practice with locations along the East Coast that owns and operates a dermatopathology laboratory settled allegations that it violated the False Claims Act by engaging in improper financial relationships with employed physicians, Department of Justice (DOJ) officials said.
"The Department of Justice has had longstanding concerns about improper financial relationships between health care providers and their referral sources, because such relationships can alter a physician's judgment about the patient's true health care needs and drive up health care costs for everybody," said Benjamin C. Mizer, principal deputy assistant attorney general of the DOJ’s Civil Division. "In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable."
The government alleged the defendants' financial relationship with a number of employed physicians did not comply with the Stark law and led to improper billing to Medicare for dermatopathology analyses. The allegations stem from three separate whistleblower lawsuits under the qui tam provisions of the False Claims Act. The defendants agreed to pay the United States $3.2 million to settle allegations that it violated the False Claims Act.
"Physician self-referrals that violate the Stark Statute undermine medical decision making, jeopardize patient care and cost the taxpayers money," said US Attorney A. Lee Bentley III of the Middle District of Florida. "Patients need to have confidence that the advice they receive from their physicians is based on sound medical practice, not illegal financial relationships between providers. We will continue to investigate and pursue these types of violations in our district."
The CAP strongly supports closing the self-referral loophole in the Stark Law protecting physicians who refer anatomic pathology services to laboratories they own or in which they have a financial interest. Several studies show the loophole in the in-office ancillary services exception in the Stark Law leads to overutilization of anatomic pathology and certain other designated health care services and also to higher Medicare spending.