Advocacy News

• Bipartisan LCD reform gains momentum. Your voice matters
• Physician groups urge Congress to enforce No Surprises Act payments
• Your AMA membership helps strengthen pathology's voice
• 2026 Medicare pay: Check your remittance advices
• ONC advisory committee examines affordability and HIT policy

Medicare local coverage determinations (LCD) shape whether patients can access diagnostic tests—including new and innovative technologies—and flawed processes can delay or deny care. 

• Pathologists have long raised concerns about inconsistent coverage decisions, limited transparency, and insufficient physician input in the LCD process.

The latest: Bipartisan legislation, the Timely Access to Coverage Decisions Act (HR 8500), is gaining traction on Capitol Hill. 

• The bill would strengthen transparency, restore appropriate stakeholder input, and help ensure coverage policies are developed and finalized in a timely, evidence-based way.
• CAP members put LCD reform on lawmakers’ radar during recent Hill Day meetings, ensuring the issue has strong visibility on Capitol Hill.

What’s next: With the bill at an early stage, broad engagement from CAP members across the country is critical now to build support and encourage additional cosponsors.

The CAP view: LCD reforms are essential to protecting patient access to medically necessary diagnostic testing—including new and emerging tests—and preventing avoidable delays or denials, while preserving physicians’ clinical judgment.

Take action: CAP members can find and message their legislators, urging them to support HR 8500 and help improve Medicare coverage policy-making for patients and pathologists.

The College of American Pathologists joined dozens of national medical specialty societies and state medical associations urging Congress to advance bipartisan legislation to strengthen enforcement of the No Surprises Act. 

The impact: The law protects patients from surprise medical bills, but physicians report delayed or missing payments after Independent Dispute Resolution (IDR) decisions.

The issue:

• Physicians report payments are not made within the required 30-day timeframe following IDR determinations.
• Some physicians report receiving no payment at all, despite decisions being final and binding.
• Practices absorb unpaid costs while insurers retain funds they are legally obligated to pay.

What the bill does: The No Surprises Act Enforcement Act (H.R. 4710 / S. 2420) would authorize penalties for parties that do not comply with statutory payment timelines after IDR decisions, giving federal agencies clear authority to enforce determinations.

Go deeper: Read the joint letter urging Congress to strengthen enforcement of the No Surprises Act.

The CAP leads on issues that matter to pathologists. The American Medical Association (AMA) House of Delegates is one of several key venues where those priorities are amplified within the broader medical community and reflected in national policy decisions.

The impact: Pathology’s influence at the AMA table is not fixed, it depends on member participation.

• The number of delegates the CAP holds depends on how many CAP members also choose to join the AMA.
• Individual decisions add up, and your membership strengthens pathology’s voice inside organized medicine.

What’s at stake: Representation at the AMA shapes outcomes on issues you care about every day, including Medicare payment, scope of practice, physician-led care, and workforce policy. A stronger presence means pathology is better positioned to protect its role and advocate effectively alongside other specialties.

The takeaway: When CAP members join the AMA, our collective voice grows more powerful. An AMA membership, in conjunction with your CAP membership, is one of the most direct ways you can help extend the profession’s influence and ensure pathologists are part of decisions that shape the future of medicine.

• Join the AMA today and help strengthen our collective voice.

Performance year 2024 Medicare Merit-based Incentive Payment System (MIPS) payment adjustments are now appearing in 2026 Medicare reimbursements.

• The CAP Pathologists Quality Registry (PQR) has received reports that some Centers for Medicare & Medicaid Services (CMS) MIPS payment adjustments may be applied incorrectly. 

The impact: This may affect pathologists who participated in MIPS and continue billing Medicare.

• Some practices with high 2024 scores appear to be receiving neutral or negative adjustments instead of the positive adjustments they earned.
• Incorrect CMS payment adjustments could result in Medicare underpayments or overpayments in 2026.

What to check: Review your 2026 remittance advice (electronic or paper) and look for the Claim Adjustment Reason Code (CARC).

• Positive payment adjustments are indicated by CARC 144: “Incentive adjustment, e.g., preferred product/service.”
• Negative payment adjustments are indicated by CARC 237: “Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).”
• You may also see Remittance Advice Remark Code (RARC) N807, which indicates that a MIPS payment adjustment applies but does not specify whether it is positive or negative.

Next steps: Confirm that your 2026 payment adjustment matches your official MIPS results.

• Log in to your QPP account at qpp.cms.gov.
• Select "Performance Feedback."
• Choose “Performance Year 2024” from the dropdown menu.
• Review your final score and payment adjustment, including any approved Targeted Review.

If the adjustment on your remittance advice does not match your final score or approved Targeted Review outcome, contact the CAP immediately.

Need help? 

• Email registry.inquiries@cap.org if you believe your MIPS payment adjustment is incorrect.
• The CAP is actively working to ensure practices receive the Medicare payments they earned.

The Health IT Advisory Committee (HITAC) of the Office of the National Coordinator for Health Information Technology (ONC) held a full-day public meeting on May 7. The discussion focused largely on health care affordability and how health IT policy can help address rising costs.

The impact: HITAC advises the ONC on federal health IT policy. CAP member Hung S. Luu, PharmD, MD, FCAP, serves on the committee. 

The big picture: ONC leaders highlighted three areas of priority:

• Affordability
• Data liquidity—secure, seamless data flow across the health system
• Health care technology innovation

Panel discussions explored how the use of artificial intelligence (AI) and crowdsourcing information tools by payers, regulators, and health IT companies is intersecting with policy issues related to prior authorization, payer practices, and price transparency under the No Surprises Act.

Key takeaway: Payer and technology representatives discussed the potential for technology to speed prior authorization, reduce burdens on providers and patients, improve price transparency, and empower consumers. 

• Other stakeholders raised concerns that AI could accelerate denials, discussed the importance of human review, and highlighted the challenges of knowing in advance the costs of individual healthcare services.

The CAP view: The CAP has long advocated for prior authorization reform and appropriate price transparency, both central to the HITAC discussion. We will continue to monitor HITAC’s work and keep members informed as policy recommendations develop.