Advocacy Update

Read the Latest Issue of Advocacy Update

October 6, 2020

In this Issue:

CAP Tells CMS to Stop ‘Devastating’ Medicare Cuts to Pathologists

In order to preserve patient access to laboratory care and mitigate financial distress due to the pandemic, the CAP opposed payment cuts to pathologists in 2021. The Centers for Medicare & Medicaid Services (CMS) had outlined the cuts—which the CAP has spoken out against for more than a year—in the proposed 2021 Medicare Physician Fee Schedule published in August. In a follow-up comment letter to the Medicare agency sent on October 2, the CAP again urged the CMS to abandon its plans to move forward with the cuts next year.

The 9% payment cuts result from budget neutrality requirements that offset the cost of major changes to evaluation and management (E/M) services set to take effect in January of 2021. The CAP strongly urged the CMS to waive budget neutrality requirements for the new Medicare office visit payment policies under the public health emergency declaration.

Additionally, the CAP urged the CMS to retain its National Coverage Determination (NCD) for therapeutic apheresis and align it with the latest American Society for Apheresis (ASFA) guidelines. The CAP also asked the CMS to consider changing timelines for clinical measures review to better align with the Physician Fee Schedule regulatory cycle.

Medicare Payment Cuts

In the October 2 letter to the CMS, the CAP outlined how the additional E/M increases will further erode payment to all other non-E/M services during the ongoing public health emergency. The CAP asked the agency to postpone these updates and value them at a later date since "valuing these services at this time, without current practice information from specialty societies, is reckless and undermines the pillars of the resource based relative value system,” the CAP stated in the letter.

The CAP has advocated to fight these cuts through direct lobbying with the CMS, Congress and encouraged members to contact their federal legislators through the #fightthecuts advocacy campaign. These cuts could not come at a worse time for pathologists, due to the effects of the current COVID-19 pandemic.

Reevaluation of National Coverage Determinations (NCDs)

The CAP supported the CMS’s initiative to remove NCDs that no longer reflect current medical practice. However, the removal of three NCDs concerning pathology services would have serious negative consequences resulting in inconsistent access to care if left to local Medicare contractor discretion.

The CAP stated that Medicare covers dialysis for many patients, so it would benefit patients to also cover medically indicated therapeutic apheresis therapies which prevent the need for dialysis or renal transplants. The CAP urged the CMS to continue to provide national coverage for therapeutic apheresis and revise its NCD to align with the latest ASFA guidelines and other scientific evidence.

Additionally, the CAP asked the CMS to reconsider its outdated policy on cytogenetic studies and would like to work “with the CMS to revise the policy terminology to reflect the advances made in genomic conditions.” Moreover, the CAP reminded the CMS of the importance of histocompatibility testing (antibody detection and identification, crossmatching, and high-resolution HLA typing), and noted that their “results are one of the most important decision points in donor selection and post-transplant immune suppression and monitoring.” The CAP asked the CMS to retain this NCD and update the policy to reflect the current scientific literature.

Merit-based Incentive Payment System (MIPS)

In the proposed 2021 Quality Payment Program (QPP) regulation, the CAP urged the CMS to consider non-patient facing physicians like pathologists, as the CMS continues implementation of the Merit-based Incentive Payment System (MIPS). For example, there are several aspects of the proposed MIPS Value Pathways (MVP) framework that do not take pathology into account. The CAP encouraged the CMS to be open to innovative thinking and have a willingness to test new ideas rather than simply reshuffling the current program as it implements MVPs.

Additionally, the CAP asked that CMS reduce the burden of complying with MIPS especially in the proposed increased requirements for Qualified Clinical Data Registries with regards to data validation and measure testing. These requirements place a significant burden on registry practices who already have to comply with a tightly wound timeline that is not practical and would be overly disruptive of the primary work of caring for patients.

The CMS is expected to release the final 2021 Medicare Payment regulations later this year.

House Lawmakers Introduce Legislation to Waive Medicare Cuts for 1 Year

Reps. Michael Burgess, MD, (R-TX) and Bobby Rush (D-IL) introduced legislation on October 3 that would waive steep Medicare cuts to certain specialists, including pathologists, in 2021. The bipartisan legislation, HR 8505, would delay the Medicare cuts temporarily until 2022.

The CAP is engaged in a major campaign to stop these Medicare cuts from taking effect. We are strongly advocating for a permanent fix and have called on all CAP member to contact their members of Congress to urge them to support legislation that prevents a 9% Medicare payment cut to pathology services.

The CAP will keep its members updated on the latest information on this issue in future editions of Advocacy Update and on the Advocacy Twitter account.

CAP Meets with UnitedHealthcare, Discusses Test Registry

On September 29, CAP leaders met with UnitedHealthcare (UHC) to express continued opposition of the insurer’s laboratory test registry.

The CAP leaders said that the new requirements will interfere with critical diagnostic care to patients and create unnecessary reporting burdens. The CAP urged UnitedHealthcare to cease implementing the program and work with the CAP to address any outstanding needs for information and transparency.

During the meeting, CAP leaders emphasized the basis for the insurer’s assertion that they need additional coding transparency is not substantiated. Further, it would not warrant the imposition of onerous and duplicative billing requirements, as the vast majority of standard laboratory service codes already specify the service provided.

The CAP also expressed concerns about laboratory responsibility for specifying the maximum service units and providing price transparency because the clinical request for diagnostic services is not under the pathologist's control. Additionally, the complexity of insurance plans makes determining the patient's liability for payment for such services complicated to assess in advance. Finally, the CAP stressed the difficulty of implementing this program during the COVID-19 public health emergency. UHC acknowledged this unique situation and said they would make adjustments as needed.

Not only did CAP leaders recently met with UHC, but also sent a letter outlining the issues with the test registry. Under the UHC program, all freestanding and outpatient hospital laboratories will need to register

Learn more about the CAP’s private sector advocacy.

Blue Cross of NC Updates Pass-Through Billing Policy

The CAP asked Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to modify its proposed professional pathology billing guidelines, which is intended in part to inhibit the practice of “pass-through” or client billing. In response, the Blue Cross NC updated their reimbursement policy stating that “pass-through” billing will be prohibited and that the “professional practice or laboratory performing the services” will directly bill for those services. The CAP strongly supports the intent of the policy but is working with stakeholders and evaluating the policy for increased reporting burdens on laboratory medicine.

In the updated reimbursement policy, Blue Cross NC stated that the professional practice or laboratory performing the services on behalf of a Blue Cross NC member must directly bill for those services. The insurer also wants to “bring the costs for surgical pathology services to parity across the outpatient places of services," and ensure that a certified accreditation agency fully accredits all professional pathology services rendered on behalf of a Blue Cross NC member.

In a July 10 letter to the insurer, the CAP stated its support for Blue Cross NC’s efforts to address pass-through billing. Still, the CAP also expressed concerns with the insurers’ proposed billing guidelines that conflict with Medicare.

Learn more about the CAP’s private sector advocacy.

New Month, New News Quiz

New month and that means a new Advocacy news quiz. See how you compare against your fellow CAP members’ by taking this month’s quiz.

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