Special Advocacy Update

• Congress Fails to Address Medicare Payment Cuts; Claims Hold Possible in January

The CAP expressed its deep disappointment after Congress will end its legislative session for 2023 without addressing future Medicare payment cuts to physician services. Overall, these services will receive a cut on January 1, 2024 after several years of similar cuts and insufficient updates to Medicare’s physician fee schedule to account for rising inflation. The CAP is still pressing lawmakers to take action and stop cuts to pathologists’ Medicare reimbursement. While Congress may address the Medicare payment cuts retroactively when they return in January, the lack of predictability in Medicare reimbursement is untenable.

CAP President Donald S. Karcher, MD, FCAP issued the following statement urging Congress to take up legislation to stop the cut as soon as lawmakers return to Washington in the New Year. The CAP supports the passage of the Preserving Seniors’ Access to Physicians Act of 2023 (HR 6683) that stops the upcoming cut to Medicare physician payment with an update to the conversion factor of 3.37%.

“Pathologists and their laboratories have endured several challenges in recent years to meet the demands of the US health system while facing declining reimbursements. Our commitment to our patients is unwavering,” Dr. Karcher said. “At the same time, physicians cannot continue to do more with fewer resources. While coping with workforce shortages and inflationary pressures, we must still invest in new technology and advance laboratory infrastructure to maintain and enhance quality patient care. Congress must honor its commitment to seniors and the physicians who care for them by stabilizing Medicare pay in the short and long term.”

The 2024 cuts are on top of the lack of an inflationary update to the physician fee schedule. According to the American Medical Association (AMA), Medicare physician pay fell 26% from 2001-2023 because physicians, unlike other Medicare providers, do not get yearly inflationary payment updates. While Congress passed legislation to mitigate the impact of the cuts in 2023 and 2024, they did not stop the cuts completely.

The CAP continues to pressure Congress to pass legislation to stop the cuts to pathology services until long-term reforms are enacted.

CMS May Issue Claims-Hold Instructions

Given the potential for congressional action in early 2024, the CAP anticipates that the Centers for Medicare & Medicaid Services (CMS) may decide to instruct Medicare Administrative Contractors (MACs) to hold claims for a short period of time to minimize the volume of claims that the MACs must reprocess if Congress acts to update physician payments. The CAP will provide additional information to its members if the CMS does issue such an order.

Throughout 2023, the CAP has lobbied Congress to stop these cuts. CAP members can continue to urge their representatives and senators to support and pass HR 6683 by using the CAP’s Action Center.