In its formal comments to the Centers for Medicare & Medicaid Services (CMS), the CAP urged the federal agency to stop Medicare cuts to pathologists next year, make the Merit-based Incentive Payment System (MIPS) less taxing on pathologists, and maintain remote sign-out capabilities for pathologists under CLIA. The CMS published the 2024 proposed Medicare Physician Fee Schedule, Quality Payment Program (QPP) regulation and a request for information regarding CLIA regulations on July 13. The CAP responded to the proposed regulation with a 25-page letter on September 11 that advocated for several changes that would protect the value of pathology services and reduce regulatory burden on pathologists.

Improve Medicare Payment to Pathologists

The CAP comments included recommendations to improve and protect the value of pathology services by updating Medicare’s data used to calculate physician fee schedule payments for both pathology services and the physician fee schedule as a whole.

The CAP also expressed opposition for the CMS to implement a new evaluation and management (E/M) add-on code, G2211, for ongoing, longitudinal patient care, as the extra service will be heavily utilized causing overall rate cuts to Medicare’s fee schedule. In the letter, the CAP called on the CMS to discard payment of G2211 as the work in the add-on code is already described and accounted for within the existing E/M code set. Implementation of G2211 would essentially mandate duplicate billing of physician services.

Proposed 2024 MIPS Reporting for Pathologists

Though limited, the proposed changes to the MIPS program could have a significant impact on pathologists’ scores and payment bonuses, the CAP stated to the CMS.

In 2024, pathologists reporting MIPS will have to act to avoid penalties that reduce future Medicare Part B payments for their services. Failing to reach the scoring threshold in 2024 could result in Medicare payment penalties up to 9% in 2026.

With the proposed 2024 increase in performance threshold to stop penalties, it is likely that many small practices –especially those that rely heavily on the topped out QPP measures-- could see a reduction in their MIPS performance scores and be penalized. Billing companies alone are not able to avoid this problem for practices. In the letter, the CAP urged the CMS to make MIPS less burdensome for pathologists and to create measures to increase pathologists’ opportunities to demonstrate the quality they provide so they can score well in the program.

CLIA Request for Information on Remote Sign-Out and More

Finally, the proposed physician fee schedule included a request for information on histopathology, cytology, and clinical cytogenetics regulations under CLIA to achieve the following objectives:

• Developing regulations around slide staining and tissue processing as a part of the wider CLIA regulations and certification
• Making the public health emergency enforcement discretion permanent to allow pathologists to review slides remotely
• Making the public health emergency enforcement discretion permanent that allows for cytogeneticists to review images remotely

In the letter, the CAP recommended CLIA modernization focus on where practice and technology necessitates updates to CLIA regulations. The CAP also supported CLIA regulations to allow for remote viewing and sign out of digital slides, while establishing appropriate controls to ensure patient safety and clinical quality.