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STATLINE brought you many news stories in 2017 to help navigate payments and Medicare Reimbursements for 2018. The CAP's efforts to protect the value of pathology services were adopted by the Centers for Medicare & Medicaid Services (CMS) in two final Medicare regulations affecting reimbursements in 2018. Moreover, the CAP continues to advocate for a better laboratory data collection process and methodology to calculate the new rates for the clinical laboratory fee schedule.

Here are past STATLINE articles that will help you navigate Medicare reimbursements in 2018:

Final 2018 Medicare Fee Schedule Regulation

The CAP successfully advocated to protect therapeutic apheresis, pathology consultation, and other pathology services targeted for revaluation, resulting in the Medicare program accepting all of the physician work recommendations for pathology services used to calculate professional component and global payment rates in the final 2018 Medicare Physician Fee Schedule. As a member of the American Medical Association (AMA)/Specialty Society Relative Value Advisory Committee, the CAP leads the effort to develop and defend values for pathology services that are targeted for review as potentially misvalued.

The CMS reported that the estimated Medicare physician payment impact on the total allowed charges for pathology and independent laboratories is a -1% in 2018. For individual physicians and practices, the impact depends on mix of services and payers (Medicare and non-Medicare). Physicians receive pay from other Medicare payment systems, for instance, independent laboratories receive 83% of their Medicare revenue from the clinical laboratory fee schedule (CLFS).

Details of the impact on pathology services resulting from this final rule are detailed in the CAP's 2018 Medicare Physician Fee Schedule Impact Table.

Check out the full STATLINE alert.

CMS Sets 2018 Medicare MIPS Rules, Adopts CAP Proposals to Ensure Flexibility for Pathologists

The CAP continues to ensure that pathologists can successfully participate in the Medicare Quality Payment Program (QPP) as the CMS adopted the CAP's recommended changes to the 2018 QPP final rule. Due to the CAP's work to develop quality measures and create opportunities for pathologists to improve performance in Medicare's quality programs, the CMS estimates that the total positive adjustment for pathology will be $5.6 million in 2020 from QPP participation.

Following recommendations from the CAP to reduce regulatory burden, continue flexibility in the program, and better reflect the practice of pathology, the Medicare program will maintain the flexibilities for non-patient facing eligible clinicians, including pathologists, as well as re-weighting of the Advancing Care Information and Cost categories of MIPS and flexible reporting requirements in the Improvement Activities category. Overall, the final 2018 Medicare QPP rule signals that year two of the Merit-based Incentive Payment System will include flexibilities while building upon year one policies with the CMS aim to prepare clinicians for a robust year three program. The CMS also noted hardship exemptions for clinicians in areas affected by Hurricanes Harvey, Irma, and Maria for both 2017 and 2018 performance periods of MIPS.

On November 2, 2017, the CMS published its final 2018 QPP rule updates with a comment period to its QPP rule that included updates advocated for by the CAP.

Check out the full STATLINE alert.

Final 2018 Clinical Laboratory Fees

The CMS published the final Medicare 2018 clinical laboratory fee schedule (CLFS) despite the CAP and other industry groups’ reservations about the laboratory data collection process and methodology to calculate the new rates.

A 2014 federal law mandated changes to the CLFS, and the CMS has since worked to implement the law. The final 2018 CLFS rates were published on the CMS website on November 17 and the full file is available for download.

The CAP analyzed the impact of the top 100 Healthcare Common Procedure Code System (HCPCS) CLFS codes by volume, which represent 80% of total CLFS spending. Download the 2018 CLFS Impact Table.

The CMS increased the 2018 rates for 25 codes, and decreased the 2018 payment rate for a single code. Furthermore, the CMS added three payment rates to the list that were not included in the preliminary rate release and deleted the payment rate for one code.

Check out the full STATLINE alert.

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On January 8, the Centers for Medicare & Medicaid Services (CMS) requested information to revise personnel, proficiency testing (PT) referral, histocompatibility, and fee regulations under CLIA. The CAP is planning to provide comments by the March 8 deadline as the potential impact could be significant if the CMS decides to move forward with drafting changes following the request for information.

The CMS is seeking input on whether a bachelor’s degree in nursing should be considered equivalent to a bachelor’s degree in biological science or should be considered a qualifying degree to meet the CLIA requirements. In addition, the CMS would like input on whether to consider a physical science degree or having that educational background such that all or some should be considered as a qualifying degree to meet the intent of the CLIA requirements.

The CAP has actively engaged in issues protecting pathologists' scope of practice. In 2016, as a result of CAP advocacy, the Department of Veterans Affairs (VA) withdrew a proposal to permit full practice authority for laboratory services to VA advanced practice registered nurses. The VA had proposed a regulation to allow its nurses to perform and supervise laboratory testing, and the proposal was strongly opposed by the CAP and broadly within the laboratory industry among multiple organizations. We believe patients are best served when only licensed pathologists are allowed to review slides and confirm diagnoses. The VA significantly changed the proposal and further clarified its intent to not have nurses take over the role of laboratory specialists.

In reference to PT referral, the CMS would like input regarding the flexibility to impose alternative sanctions for laboratories issued a Certificate of Waiver determined to have participated in PT referral. The CAP also has engaged on the issue of PT referral regulations in recent years. In 2014, the CMS implemented changes mandated by the Taking Essential Steps for Testing (TEST) Act. The CAP strongly advocated for the law because laboratories faced draconian sanctions for inadvertent PT referrals. Regulations as a result of the Test Act included three-tiered categories of sanctions for PT referral based on the severity and extent of the violation; and created an exception to the one year laboratory owner ban. The changes included a more reasonable approach for the CMS to use during its enforcement discretion for PT referral infractions.

Stay tuned to STATLINE for updates on this matter.

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Registration is open for the 2018 CAP Policy Meeting.

The CAP's annual Policy Meeting, which is scheduled April 30–May 2, at the Washington Marriott in Washington, DC, will connect CAP members 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’s 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 Policy Meeting will also include discussions with congressional offices 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 Policy Meeting is a benefit of CAP membership. There is no fee to register.

Register for the 2018 Policy Meeting.

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