Read the Latest Issue of STATLINE
April 9, 2019
In This Issue:
CAP Urges Medicare to Rescind Recent Edits to National Correct Coding Initiative Manual
The CAP and laboratory industry groups are concerned about inconsistent guidance from the recently published National Correct Coding Initiative (NCCI) Policy Manual that affects payment for laboratory tests for Medicare beneficiaries. In a letter sent to the Centers for Medicare & Medicaid Services (CMS) on March 17, the CAP and nine other laboratories groups argued that recent policy manual changes were made “without notice or stakeholder input,” and are highly disruptive to the CPT coding and payment for clinical laboratories and pathology testing.
“We urge you to withdraw these changes and to work with stakeholders to address any concerns the [CMS] may have regarding billing for clinical laboratory and pathology services,” the letter stated. “Any evaluation of these policies should reflect the current standard of care in test ordering and performance and include an opportunity for stakeholders to review and provide comment on draft policies prior to their finalization and implementation.”
The NCCI policy manual is released on the CMS’ website at the end of each calendar year after publication of the final Medicare Physician Fee Schedule and the clinical laboratory fee schedule. The CAP and other stakeholders have grown increasingly frustrated by the lack of a formal process to seek, acknowledge, and incorporate public review and comment on the manual prior to its annual publication.
In addition to the CAP, the March 17 letter was signed by AdvaMedDx, American Association for Clinical Chemistry, American Clinical Laboratory Association, American Society for Microbiology, Association for Molecular Pathology, Coalition for 21st Century Medicine, Physician Fee Schedule Pathology Payment Coalition, and the Point of Care Testing Association.
Policy Meeting: Experts to Discuss Pathologists’ Concerns on Network Adequacy, Out-of-Network Bills
The CAP has been fighting for network adequacy to require health plans to have adequate networks of pathologists and hold patients harmless during “surprise billing” scenarios. At the 2019 Policy Meeting, pathologists will hear from policy experts as they discuss the impact of inadequate insurance networks on patients and pathologists.
The surprise billing issue has captured the attention of federal lawmakers. During this session, attendees will learn about the CAP’s continued advocacy on the issue and what remedies federal lawmakers are proposing to ensure patients are held harmless in these billing scenarios. The panel will feature Matthew R. Foster MD, FCAP, a member of the CAP Federal and State Affairs subcommittee. Joining Dr. Foster will be Rita Habib, PharmD, MPH, who is the Health Policy Advisor for Sen. Michael Bennett (D-CO), and Loren Adler, PhD, who is an Associate Director at the Brookings Center for Health Policy, a well-respected think tank. The panel discussion will be moderated by Council on Government and Professional Affairs Chair Donald S. Karcher, MD, FCAP.
Time is running out to register for the 2019 Policy Meeting April 29-May 1 in Washington, DC. In addition to unique opportunities to hear from leaders and newsmakers in US politics, the 2019 Policy Meeting is your chance to speak directly to members of Congress and their staff during the CAP’s annual Hill Day on May 1. The 2019 Policy Meeting is the pathologist’s opportunity to educate legislators and policy experts on the value that pathology brings to the health care continuum.
Surprise Medical Bills Gets its First Congressional Hearing
On April 2, the House Health, Employment, Labor and Pensions Subcommittee of the Education & Labor Committee held a hearing on surprise medical bills. The hearing explored the scope of the problem and gathered testimony from employer benefit, academic, and patient advocacy groups. On this issue, the CAP has strongly advocated to require health plans to have adequate networks of hospital-based physicians and hold patients harmless during “surprise billing” scenarios.
The members of the subcommittee, which has jurisdiction over some laws that regulate surprise bills, heard from the Brookings Institution, the American Benefits Council, Families USA, and the Georgetown University Health Public Policy Institute.
During the hearing, the groups testified on two key messages. The first was to take patients out of the role of negotiating with insurers for out-of-network payments after receiving a surprise bill, and second is that hospitals and insurers must remove the incentives for doctors to remain out-of-network. There was a great deal of discussion about which state models worked as well.
Rep. Phil Roe, MD (R-TN), a physician on the committee, brought a much needed provider perspective on the issue, and discussed how certain providers must deliver services based on Emergency Medical Treatment and Active Labor Act, which results in engaging out-of-network providers for diagnostic tests and imaging, causing surprise bills for patients.
Network adequacy and balance billing influence the market value of pathology services, regardless of whether a pathologist is an employee or an independent contractor. In the best interest of the patient, the CAP wants the final federal legislation to provide that health plans maintain robust networks of physicians to ensure timely access to care for all insured patients.
The CAP’s position is supported by a number of health care organizations and patient advocacy groups and has advocated ensuring health plan network adequacy for all patients. The CAP expects surprise billing legislation to be introduced in the next few months and needs members to help provide an essential voice in the policy process.
The CAP encourages members to join and utilize PathNET, the CAP’s advocacy network, which has resources and tools for CAP members to connect with their elected officials at the federal and state level. And this is one of the best times to engage with PathNet, as the CAP needs your critical physician voice on this national issue.