Read the Latest Issue of STATLINE
October 25, 2016
In This Issue:
Medicare Contractors Remove Restrictions on Coverage for Lynch Syndrome Testing
The Medicare Administrative Contractor (MAC) Palmetto GBA has removed age restrictions from its coverage policy for Genetic Testing for Lynch Syndrome. The Medicare local coverage determination (LCD) policy, which was developed by Palmetto's MolDx program, affects physicians and patients in 25 states.
The CAP and American Gastroenterological Association (AGA) urged Palmetto to revise the LCD to reflect the standard of care recommended by the National Comprehensive Cancer Network, AGA, the Multi-Society task force, and others, that support universal testing for Lynch Syndrome for colorectal cancer (CRC) patients, regardless of age.
The LCD had inappropriately limited LS testing to patients with CRC diagnosed at age ≤70 years, and those > 70 years who meet the revised Bethesda Lynch Syndrome guidelines. As the policy was written, the LCD excluded medically necessary immunohistochemistry and Microsatellite instability testing in appropriate individuals who are candidates for CRC screening as per the United States Preventative Services Task Force, and are found to have CRC but do not meet the revised Bethesda Lynch Syndrome guidelines.
The change to remove the age restriction became effective October 13 for Palmetto, which processes Medicare Part A and Part B fee-for-service claims for the states of North Carolina, South Carolina, Virginia and West Virginia, and Cigna Government Services, which processes claims for Kentucky and Ohio. Noridian Administrative Services and Wisconsin Physician Service (WPS) are expected to update its MolDX policy in the near future, which will affect Medicare beneficiaries in thirteen more states covered by Noridian (Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming) and six states overseen by WPS (Indiana, Iowa, Kansas, Michigan, Missouri, and Nebraska).
New Webinar: How Medicare Pay Reforms Under MACRA Will Affect Pathologists
In 2017, most pathologists will need to take action to stop penalties from reducing future Medicare payments for their services. On November 2, the CAP will host a 60-minute webinar to discuss 2017 options for preventing Medicare penalties and, in certain cases, increase reimbursements in 2019. The webinar will begin at 2 PM ET/1 PM CT.
On October 14, the Centers for Medicare & Medicaid Services (CMS) issued its final rulemaking that implemented provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Measurement for new quality payment programs will begin in 2017 and affect Medicare reimbursement in 2019. One payment pathway, the Merit-based Incentive Payment System (MIPS), is projected to have a $1.5 billion impact on pathology reimbursement between 2019 and 2024.
Key elements in the final MACRA regulation include:
- Additional flexibility with four MIPS participation options for physicians.
- Pathologists, including pathologists practicing at independent laboratories, are considered eligible for MIPS and are required to participate in the program
- A new definition of non-patient-facing physicians
- Reduced risk criteria for alternative payment models (APMs).
CAP Webinar: Medicare Changes in Pathology Reimbursement for 2017
Find out what Medicare will pay for pathology services in 2017 by registering and attending the CAP's webinar The Final 2017 Medicare Physician Fee Schedule’s Impact on Pathology Services. The CAP will host this presentation for members on November 8 at 2 PM ET/1 PM CT.
Throughout this hour-long panel discussion, CAP experts will explain the changes by the CMS in the 2017 Medicare Physician Fee Schedule. Expected to be published by the CMS in late October, the fee schedule contains Medicare reimbursement and policy changes affecting pathologists.
In July, the CMS provided detail on its intention to revalue certain pathology services targeted as potentially misvalued. For 2017, the CMS proposed increases for:
- Pathology add-on services
- Microslide consultations
- Prostate biopsy, any method G-code
- Tumor immunohistochemistry
The CMS also proposed decreases in the physician work and practice expense for some services, such as flow cytometry.
During the webinar, CAP experts will discuss how the final rule affects Medicare reimbursement for pathology services and the CAP's advocacy efforts to impact these changes. The second part of the webinar will be a question-and-answer session.
Dr. Deck: CAP Advocacy Is Important for Pathology to Flourish
Each month, STATLINE will feature one of the many CAP members who have been champions for pathology in Washington and at the state level through our grassroots and PAC programs. If you would like to get involved, you can join PathNET, contribute to PathPAC, or join your state pathology society.
Name: Michael A. Deck, MD, FCAP
Position: President and Chief Pathologist, MD Pathology, Plano, Texas
How did you first get involved in advocacy with the CAP?
My chairman during residency, Dr. Vernie Stembridge, strongly encouraged his residents to get involved in organized medicine. His encouragement got me involved with the CAP and Texas Society of Pathologists, and it became clear that advocacy was important if our specialty was to flourish.
Why is advocacy important to you?
As pathologists, we are a very small slice of the physician pie, and yet our specialty is very different from most. If we don't advocate for ourselves, bad things are bound to happen, often unintended, but adverse to pathology nonetheless. Advocacy is key to how we get the word out and either head off problems before they hatch, or mitigate them once they have emerged.
What advice would you give to someone who wants to be involved in advocacy?
Develop relationships with your legislators on both a state and national level. Attend fundraisers. Contribute to campaigns, even if it is not a lot. Drop by for a face-to-face meeting when the legislator is in the local office. Attend the CAP Policy Meeting to learn about the latest issues and be coached on effective advocacy techniques. Case in point: I met with John Deoudes in Rep. Kenny Marchant's office during a recent Policy Meeting to talk about LCDs. Having developed a relationship, we were later successful in getting Rep. Marchant to sign on as a cosponsor to our LCD bill [HR 5721, the Local Coverage Determination Clarification Act—visit the CAP Action Center to email your legislators].