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Due to pathologists lobbying their congressional offices during the 2018 Policy Meeting, the Local Coverage Determination Clarification Act of 2017 bill has gained more cosponsors. In addition to Sen. Bill Cassidy, MD (R-LA), the CAP added Sen. Tom Cotton (R-AR), who joins 16 other senators in support of this bill.

The Hill Day meetings also resulted in four additional House members who committed their support to the bill. New sponsors in the House are Rep. Glen Thompson (R-PA), Rep. C.A. Dutch Ruppersberger (D-MD), Rep. Scott R. Tipton (R-CO), and Rep. Peter A. DeFazio (D-OR). These 4 House members join the 56 other representatives who are cosponsors of the bill.

The CAP's Annual Hill Day included 78 pathologists who had 135 meetings with both House and Senate offices. STATLINE will continue to provide updates of the LCD reform legislation.

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The Centers for Medicare and Medicaid Services will release the final scores for the 2017 Merit-based Incentive Payment System (MIPS) performance period on July 1, 2018.

The preliminary 2017 MIPS scores are currently available, but these estimates do not reflect the special circumstances for pathology practice, such as non-patient facing and hospital-based clinician status. As a reminder, you can check your special status using your 10-digit National Provider Identifier (NPI) number at

Between now and June 30, 2018, your score could change based on the following:

  • Special Status Scoring Considerations (eg, Non-patient facing and Hospital-based Clinicians)
  • Claims Measures to include the 60-day run out period
  • Advancing Care Information Hardship Application status
  • Improvement Study Participation and Results
  • Creation of performance period benchmarks for Quality measures that didn’t have a historical benchmark

Your final score and feedback will be available on July 1, 2018 through the Quality Payment Program website. You will be able to access preliminary and final feedback with the same Enterprise Identity Management (EIDM) credentials that allowed you to submit and view your data during the submission period.

An eligible physician’s 2019 Medicare payment will be adjusted based on the 2017 MIPS score. Payment adjustments for 2019 will range from -4% to +4% depending on a final MIPS score from 2017.

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The CAP and the Connecticut Society of Pathologists (CSP) have prevailed in their efforts to prevent passage of two separate bills that would have adversely amended the current law banning balance billing in a hospital setting.

SB 210 would have amended the statutory definition of “surprise billing” to include certain out-of- network (OON) laboratory services if referred to by an in-network provider. The CAP and the CSP, however, argued that there are instances where patients might voluntarily select an OON laboratory and the bill they would receive would not be a surprise. The groups had urged that SB 210 be amended to exempt OON laboratory services voluntarily selected by the patient and to designate urgently needed pathology and laboratory services provided when the patient is incapacitated as “emergency services.”

HB 5039 would have changed current law requiring insurers to reimburse OON emergency services the greater of the in-network rate; the usual, customary and reasonable rate (UCR); or the amount Medicare reimburses for those services. Under the bill, OON services would be reimbursed solely at the in-network rate.

In comments opposing the bill, CSP President William Frederick, PhD, MD, FCAP, noted that the current OON payment formula used in Connecticut, which is established at the 80th percentile of an independent charge database, emulates current New York state law for determining “usual and customary” market value for physician services.

“This formula was established in New York statute to address the improper business practices in the health insurance industry that calculated usual and customary rates in a biased fashion to benefit the health insurance industry,” said Dr. Frederick. “The only rationale to change this formula in Connecticut is to financially reward health insurance companies with greater profits and to allow them to revert to the egregiously improper business practices they were engage in prior to reaching the settlement with the New York state attorney general.”

That 2009 settlement led to creation of the independent market database and the use of the 80th percentile of charges as the method for calculating UCR.

While SB 210 passed the Senate April 25, it did not pass the House before the Connecticut General Assembly adjourned May 9. HB 5039, meanwhile, failed to pass the House or Senate. Unfortunately, the successful effort to defeat both bills this year has led to a delay in the coalition efforts to secure parity in payment for OON emergency and non-emergency services until next year.

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It’s the final week of the 2018 Practice Leader Survey and Claudio A. Moss, MD, FCAP, is this week’s winner of the $150 Amazon gift card. Dr. Moss was randomly selected for completing the 2018 Practice Leader Survey.

It’s not too late to complete the 2018 Practice Leader Survey and still win the prize for week 4: an Apple Watch Series 3, which is valued at $349. All survey participants from the past 3 weeks are eligible for the Apple Watch drawing.

Help the CAP by providing your latest information about practice demographics, patient case mix, staffing trends, impacts of mergers and acquisitions, and the impact from regulatory issues and an evolving healthcare marketplace.

The 2018 PLS is the second CAP Policy and Advocacy survey targeting pathology practice leaders. Practice leaders should have received an email with the survey link. If you have not received the link, here it is The link was sent to practice managers and administrators, with a request that they bring the survey to the attention of their practice leader. CAP members should encourage their practice leader to take the survey, which only takes 20 minutes to complete. There will be one survey per practice.

The PLS is confidential. Anyone taking the survey will remain anonymous and results will only be shared in aggregate form.

For questions about completing the survey, or if you want to make sure that your practice leader received the survey, please email

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STATLINE will take a scheduled break on May 29 to observe Memorial Day. You will receive the next edition of STATLINE in your email inbox on June 5. Please continue to check the CAP Twitter and Facebook accounts for updates from the CAP.

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