STATLINE

Read the Latest Issue of STATLINE

In This Issue:

• Time is Running Out for 2017 MIPS Reporting
• NY Allows Pathologists to Communicate Directly with Patients
• CAP Scores a Win With NCOIL Balance Billing Model Act
• Watch the 2018 Medicare Quality Payment Program Impact on Pathologists Webinar
• Registration Now Open for the 2018 Policy Meeting

Time is running out to report your 2017 data if you are included in the Centers for Medicaid and Medicare Services, (CMS) Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS). As a reminder, your 2017 data will determine how your 2019 Medicare payments will be adjusted up, down, or not at all. The deadline to enroll in the CAP's MIPS Reporting Solution is January 5, 2018.

If you are unsure of your MIPS reporting status, you can enter your National Provider Identifier (NPI) to check to see if you are included in an Alternative Payment Program (APM). If you are part of an APM, then you don't need to report for MIPS. If you are not part of an APM, then check your MIPS status to see if you are eligible for reporting. Clinicians who (1) enroll in Medicare for the first time in 2017; (2) bill Medicare for $30,000 or less; (3) have provided care for 100 Medicare patients or fewer; or (4) are not in a MIPS-eligible specialty, are exempt from the MIPS program.

If you do qualify to report for MIPS, it is not too late to use the CAP’s 2017 MIPS Reporting Solution tool manually enter quality measures data and/or attest to Improvement Activities to avoid the penalty and aim for a bonus. The enrollment deadline for the CAP's 2017 MIPS Reporting Solution is January 5, 2018.

Already covered for 2017 and starting to plan for 2018? The CAP hosted a webinar regarding the new MIPS reporting requirements for 2018 and the recording is here.

The CAP is offering a CMS-approved qualified clinical data registry—the Pathologists Quality Registry—for 2018 MIPS reporting. The cost for the 2018 Pathologists Quality Registry is $299 per CAP member per year. Non-members may also enroll in the Pathologists Quality Registry at a cost of $799 per pathologist per year. For a practice, the total cost for participating in the registry will be the sum of the price for each practicing pathologist in the group.

Enrollment is now open for the Pathologists Quality Registry for 2018 MIPS reporting. Click here to learn more.

Here is a breakdown of important deadlines and differences for 2017 and 2018 MIPS reporting and the CAP reporting tools that are available.

If you have further questions about MIPS reporting of either of the CAP's MIPS reporting tools, please email registry.inquiries@cap.org.

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The New York State Department of Health has adopted a new rule that allows licensed laboratory physicians to answer patient questions, regarding the meaning or interpretation of test results. The rule took effect November 22, 2017.

The New York law had prohibited certain communications between a clinical laboratory and a patient of a referring health care provider to prevent kickbacks or other payment from being given for referral of laboratory services. To prevent such kickbacks, the regulation previously required clinical laboratories to direct a patient's inquiries about test results to the referring provider.

After extensive advocacy by CAP and the New York State Society of Pathologists (NYSSPATH), the Department of Health agreed that communication between pathologists and patients regarding test results is necessary and should not be legally impeded.

The CAP supports allowing pathologists to communicate directly with patients when deemed necessary. In June of this year, the CAP reaffirmed a consensus statement developed in 2012 on effective communication of urgent diagnoses.

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In a win for the CAP and physician groups, the Executive Committee of the National Conference of Insurance Legislators (NCOIL) on November 19 adopted an out-of-network (OON) balance billing transparency model act defining "usual, customary and reasonable" as the 80th percentile of similar charges as determined by the FAIR Health database. The NCOIL is an organization of state legislators whose main area of public policy concern is insurance legislation and regulation.

The approval of the NCOIL model further validates CAP arguments that out-of-network pathologists, and other out-of-network physicians, should be compensated at a "usual and customary rate," that is based on the market value of the service, as opposed to Medicare or in-network rates—which are adverse formulas advocated by the insurance industry. States are not obligated to follow the NCOIL model, but given that State Legislative Insurance Committee chairs approved the model, it further adds support to the out-of-network payment position advocated by the physician community.

A number of physician groups, including the CAP, the American Medical Association (AMA), Physicians for Fair Coverage and the Coalition of Medical Specialties, had advocated for UCR charges to be based on the 80th percentile of all charges for a particular health care service performed by a provider in the same or similar specialty and provided in the same geographical area as reported in a benchmarking database.

In testimony submitted to the NCOIL on November 18, the AMA urged that health insurers' OON payment reflect the cost of providing care to incent insurers and physicians to enter into fair contracts. In supporting the model act’s use of the 80th percentile of charge data from an independent source as the basis for usual and customary costs, the AMA noted that the FAIR Health database is often identified as the most comprehensive source for independent charge-based data.

The Coalition of Medical Specialties, of which the CAP is a member, had also urged NCOIL to adopt the 80th percentile as the UCR standard, noting that this is consistent with New York law and with what many health plans are already doing. "NCOIL should not allow health insurance plans to revert to unilateral, opaque payment practices, based upon amounts 'paid for services' as determined by the plan, as such an approach will likely enrich these plans to the detriment of health care delivery," the coalition wrote in a recent letter to the NCOIL.

The CAP will continue to advocate for fair reimbursement for OON providers. Watch future issues of STATLINE for updates.

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As the CMS has now finalized rules for the 2018 Quality Payment Program, the CAP has tools, such as recorded webinars to help prepare and plan for next year’s MIPS performance period.

The CAP hosted a 60-minute webinar to review 2018 options for preventing Medicare reviewed the Medicare program changes under the Quality Payment Program will affect pathologists in 2018.

Watch the webinar.

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Registration is open for now the 2018 CAP Policy Meeting–Protecting the Practice of Pathology and Our Patients.

The annual CAP policy meeting, which is set for from April 30–May 2 at the Washington Marriott in Washington, DC, enables CAP members to connect with government leaders and policy experts to discuss the impact of federal regulation on their pathology practices.

New regulations are taking shape that will impact pathology reimbursements for years to come. Attendees at the CAP Policy Meeting will receive the latest information and analysis on the implementation of new Medicare and laboratory regulations. The CAP is actively engaged in the legislative and regulatory arenas on the critical issues facing pathology and laboratory medicine, including physician payment reform, reducing regulatory burdens, and improving health care quality.

The CAP Policy Meeting will also include meetings with members of Congress and their staff during the CAP's Annual Hill Day on May 2, which is the specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.

The CAP Policy Meeting is a benefit of CAP Membership. There is no fee to register.

Register for the 2018 Policy Meeting.

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