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The Centers for Medicare & Medicaid Services (CMS) plans to move forward in 2016 with the new Protecting Access to Medicare Act (PAMA) regulations affecting laboratory operations and future clinical laboratory fee schedule (CLFS) Medicare payments. The regulations require collecting from applicable laboratories data on payments received from private payers for clinical laboratory services and basing CLFS payments on the weighted median of this information in 2017. Applicable laboratories as defined under the proposed rule could face significant monetary penalties for non-compliance.

The CAP will host an important webinar on the PAMA regulation December 17 at 2 PM (ET). During this 60-minute webinar presentation, pathologists and laboratory managers will receive important information about the proposed PAMA regulation including the CAP’s concerns and recommendations to the CMS. Information covered during the webinar will include:

  • New Reporting Requirements for Laboratories
  • Coding Implications for CLFS services
  • Medicare Coverage and Claims Processing Consolidation Feedback

The webinar will be held December 17 at 2PM (ET). Register for this important program today.

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Dr. Martinez-Torres and Senator Baldwin

CAP PathPAC Ambassador Guillermo Martinez-Torres, MD, FCAP, recently met with Sen. Tammy Baldwin (D-WI) during an event and spoke about issues important to pathology.

"It was truly a surprise to receive a personal phone call from Senator Baldwin asking me to have lunch on a recent trip home," Dr. Martinez-Torres said.

"The ability to have this sort of relationship with our lawmakers is crucial and priceless. My involvement with the CAP has allowed this sort of access to occur. If your lawmaker is having an event or town hall, I would strongly encourage you to make time and start your own relationships."

Learn more about the CAP's PathPAC and PathNet programs.

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Five Medicare Administrative Contractor (MAC) jurisdictions covering 20 states and Puerto Rico have now implemented the local coverage decision (LCD) for special histochemical stains and immunohistochemical stains.

The CAP has strenuously opposed this LCD through a series of comment letters to MACs, in-person meetings with CMS, and by engaging members at local and national levels. The CAP also drafted proposed legislation to reform the way MACs are developing and implementing LCDs. The legislation would ensure that coverage decisions are made by qualified health experts through a transparent process that is based on sound medical evidence and that LCDs do not impede a physician’s medical judgment and deny patients access to medically necessary care.

The five MAC jurisdictions are Palmetto (NC, SC, VA, WV); CGS (OH, KY); Noridian JE (CA, HI, NV); Noridian JF (AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY); and First Coast Service Options (FL, PR).

The LCD places limits on special stains and IHC stains on a wide array of areas including breast cancer, gastrointestinal diseases, prostate disease, lung cancer, tumor profiling, cervical/GYN/bladder/kidney tumors, skin/soft tissues and peripheral nervous system lesion and bone marrow samples.

The CAP is urging its members to contact regarding any payment denials or other issues of concern relating to this LCD.

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The CMS again gave physicians more time to request an informal review of 2016 penalty adjustments under the Medicare Physician Quality Reporting System (PQRS). The deadline to request a review is December 16.

Informal review requests can be made through the CMS' quality reporting portal. Individual eligible professionals, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between by December 16. All informal review requestors will be contacted via email of a final decision by the CMS within 90 days.

The CMS has published a fact sheet about the 2016 penalty.

Previously, the CMS extended the deadline after receiving concerns from the American Medical Association about potential problems with accessing PQRS and quality resource use reports. Physicians are encouraged to review the reports because any errors contained in the reports could negatively affect Medicare reimbursements in 2016. The 2016 penalty is based on 2014 quality reporting activity.

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