In the proposed regulations from the Centers for Medicare & Medicaid Services (CMS), the CMS plans to update its price transparency policy, authorize physician assistants to receive direct payments for Medicare services, and reevaluate specimen collection fees in the Medicare clinical laboratory fee schedule. The CAP is reviewing the impacts of the proposed regulation on pathologists, including protecting the specialty’s scope of practice.

On July 13, the CMS released the proposed 2022 Medicare payment regulations, which included the Medicare Physician Fee Schedule and Quality Payment Program requirements. The CAP provided its initial analysis of the regulations, including updates on new pathology consultation codes and our impact table showing how fees for pathology services would change in 2022.

Price Transparency

CMS proposes to increase the penalty for some hospitals that do not comply with its Hospital Price Transparency final rule. Specifically, CMS is proposing to set a minimum civil monetary penalty of $300/day that would apply to smaller hospitals with a bed count of 30 or fewer and apply a penalty of $10/bed/day for hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500. The CAP has urged the CMS to consider the complexity of pathology practice when drafting a regulation that would require most group health plans and health insurance issuers to disclose the price and cost-sharing information to participants, beneficiaries, and enrollees. While the CAP supports patient access to appropriate price information before receiving physician services and other medical care, the CAP has urged the agency to consider unintended consequences that delay services for patients due to difficulties in determining the cost of pathology services in advance.

Scope of Practice

The CMS proposed to make direct Medicare payments to physician assistants for professional services they furnish under Part B beginning January 1, 2022. Medicare currently can only make payments to the employer or independent contractor of a physician assistant. Consequently, physician assistants could not bill and be paid by the Medicare program directly for their professional services; they also did not have the option to reassign payment for their services or to incorporate with other physician assistants to bill the program for their services. The change does not change the statutory benefit category or the requirement that physician assistant services are performed under physician supervision. The CAP and the AMA have worked with the CMS to ensure that physician assistants work under the direction of a medically trained physician.

Beginning January 1, 2022, physician assistants would bill Medicare directly for their services and reassign payment for their services.

Clinical Laboratory Fee Schedule Updates

To be as expansive as possible within the current authorities to have diagnostic testing available to Medicare beneficiaries during the COVID-19 public health emergency, the CMS changed the Medicare payment rules to provide payment to independent laboratories for specimen collection from beneficiaries who are homebound or inpatients not in a hospital for COVID-19 testing under certain circumstances and increased payments from $3-5 to $23-25.

The CAP has sought clarification on specimen collection fee policies and the travel allowance and calculates costs for transportation and personnel expenses for trained personnel to collect specimens after the COVID-19 public health emergency ends. In the proposed regulation, the CMS proposes to make permanent the option for laboratories to maintain electronic logs of miles traveled to cover the transportation and personnel expenses for trained personnel to travel to collect a specimen sample.

The CAP is reviewing the proposed payment regulations and will review them on August 5 at 1 PM ET/ 12 PM CT during an exclusive members-only webinar.