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More senators and representatives signed on as co-sponsors to the Local Coverage Determination (LCD) Clarification Act after CAP members lobbied their elected officials to support the legislation that increases transparency and accountability in the LCD process. The LCD bill has support from 97 members of the House and Senate, with 76 members in the House and 21 Senators. The recent Senate co-sponsors include Sens. Catherine Cortez Masto (D-NV), Doug Jones (D-AL), and Rand Paul, MD (R-KY).

Recently, CAP members flew to Washington, DC, and helped secure support from Rep. Bill Huizenga (R-MI). In addition to Rep. Huizenga from the House, the CAP added Reps. Will Hurd (R-TX), Eric Crawford (R-AR), Adrian Smith (R-NE), Bennie Thompson (D-MS), Bruce Westerman (R-AR), Debbie Lesko (R-AZ), Bradely Byrne (R-AL), Eddie Bernice Johnson (D-TX), and John Duncan Jr. (R-TN) as co-sponsors of the LCD bill.

If enacted the legislation would pave the way for much-needed LCD reform. For example, the legislation includes improvements to the LCD process that ensure that medical evidence is not used selectively to deny appropriate coverage to Medicare beneficiaries.

STATLINE will continue to report on LCD updates in the future.

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The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued a report on the initial implementation of Medicare’s new payment system for clinical diagnostic laboratory tests that were mandated under Protecting Access to Medicare Act of 2014 (PAMA). The report, titled “Setting Medicare Payment Rates for Clinical Diagnostic Laboratory Tests: Strategies to Ensure Data Quality,” was required by the PAMA legislation and focuses on the Centers for Medicare and Medicaid Services (CMS’s) implementation activities in 2017 and the new payment rates that took effect on January 1, 2018.

The report, which was compiled using interviews with the CMS and laboratory industry staff, indicates that laboratories reported difficulty in determining whether they met criteria they needed to report data. The report also explained that while limited reporting may not have had a meaningful effect on 2018 rates, this remains a risk in future data reporting periods. Finally, the OIG also found that the CMS’s limited quality assurance efforts present an ongoing risk. The OIG will continue to issue an annual analysis of the top 25 laboratory tests, based on Medicare Part B payments, and other analyses that the OIG determines appropriate regarding the implementation and effect of the new payment system.

“Complete and accurate data are essential to setting payment rates for laboratory tests, and [the] CMS should address challenges from 2017 to ensure data quality in the future,” the report concludes. “Effective outreach can help ensure that all laboratories required reporting data [to] comply during future data reporting periods. [The] CMS can help ensure data quality by assessing quality assurance efforts and compliance activities.”

A summary of the OIG report can be found here.

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The CAP is currently asking Congress to support reforming PAMA to reflect an accurate, market-based payment system for laboratories paid through the clinical laboratory fee schedule (CLFS).

In order to reach this goal, improvements to PAMA are needed to ensure that the data collected by the CMS accurately reflects all sectors of the clinical laboratory market, allow for validation of data collected by the CMS, re-calibrate the cuts to reflect the original three-year savings figure, and to reduce burdensome reporting requirements.

The CAP and other laboratory groups are targeting congressional leadership urging them to take on this issue before this session of Congress ends.

Visit the Action Center to email your legislator today and urge them to support PAMA reform!

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Navigating all the requirements related to successfully complying with MIPS can be confusing; especially for non-patient-facing physicians such as pathologists. And on top of that, you may be at risk for losing bonus opportunities if you don’t fully optimize your participation.

As part of our ongoing commitment to ensure pathologists are able to successfully participate in new and evolving payment models, the CAP is pleased to offer a comprehensive MIPS education webinar series specifically developed for pathologists, led by experts who will take a deep dive into components of the MIPS program. Upon completing the six webinars in this program, you will fully understand program requirements, be able to optimize your participation and successfully comply with MIPS.

Diana Cardona, MD, FCAP

The first in this webinar series – Maximize Your MIPS Bonus Potential – will take place on Thursday, August 9 at 12 PM ET/ 11 AM CT. During this 30-minute webinar, Diana Cardona, MD, FCAP, Chair of the Economic Affairs Measures & Performance Assessment Subcommittee, will review key elements of the MIPS program as it relates to understanding and maximize scoring, including selecting the right measures and improvement activities that have the maximum scoring and bonus point potential. Register today.

Attendees can submit their questions about MIPS points and scoring in advance when they register for the webinar.

Other webinars in the MIPS series are open for registration:

MIPS Reporting: Which Path is Right for Your Practice?
Thursday, September 6, 2018, 11AM ET
Emily Volk, MD, MBA, FCAP
Explore the MIPS readiness checklist and learn how to choose the best reporting options for your practice.

Pathologist Improvement Activities Under MIPS
Tuesday, September 20, 2018, 1PM ET
Diana Cardona, MD, FCAP
Discuss strategies to maximize the 15% of MIPS total score for Improvement Activities and review the activities that are most applicable to you.

2019 Final Medicare Policy and Payment Changes
W Stephen Black-Schaffer MD, FCAP
Donald S. Karcher, MD, FCAP
Emily Volk, MD, MBA, FCAP
Details coming soon.

Quality Measures that Will Improve Your MIPS Score
Tuesday, December 4, 2018, Noon ET
Diana Cardona, MD, FCAP
Examine ways of improving your performance and MIPS scores using CAP-developed quality measures.

Steps to Take Before Reporting MIPS Data
Tuesday, January 8, 2019, 3PM ET
Emily Volk, MD, MBA, FCAP
Discover ways of maximizing your scoring for 2018 before submitting results to CMS.

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On July 24, the CAP hosted a complimentary webinar where CAP experts reviewed the proposed 2019 Medicare Physician Fee Schedule and the QPP regulations changes that will impact payment for services and pathologists’ participation in MIPS. Donald S. Karcher, MD, FCAP, Emily E. Volk, MD, FCAP and W. Stephen Black-Schaffer MD, FCAP reviewed these proposed changes in depth and answered questions from participants.

The webinar recording and slide deck are available on The CMS will finalize the 2019 Physician Fee Schedule and Quality Payment Program regulations during the fall of 2018.

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As reported in the July 10 issue of STATLINE, eligible pathologists who submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, can now view their performance feedback and MIPS final score. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review from the CMS until October 1, 2018.

CMS Office Hours

If you have 2017 MIPS score questions and think you need a targeted review, the CMS will answer questions about performance feedback and targeted review on August 14, 2018 from 2 PM - 3 PM ET. Register here for the CMS office hour. Space for these sessions is limited so register soon to secure your spot.

CMS Demo Videos

To help you access your performance feedback for the 2017 performance year or request a targeted review, the CMS has posted four new demonstration videos below:

  1. How to Request a Targeted Review - demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment.
  2. How to Access Performance Feedback for APM Entities - provides an overview of how to access 2017 MIPS performance feedback for Alternative Payment Model (APM) Entities.
  3. How to Access Performance Feedback for Individuals - demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group.
  4. How to Access Performance Feedback for Voluntary Submitters - provides an overview of how to access 2017 performance feedback data for a clinician who voluntarily submitted data for 2017.

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