Advocacy Update

Read the Latest Issue of Advocacy Update

• CDC COVID-19 Testing Guideline Change Draws Concern from CAP, Physicians
• CAP Opposes HHS Lab Penalties for COVID-19 Data Reporting
• CAP Objects to UnitedHealthcare’s Test Registration, Requests Meeting
• CAP Asks CMS to Increase Reimbursement for COVID-19 Testing
• The CAP Wants to Know How COVID-19 Impacted Your Practice
• Check Out the Exclusive CAP PFS Fee Impact Calculator
• Take the New September News Quiz
• Editor’s Note

The CAP asked the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS) to provide the scientific rationale for changes the administration made to federal COVID-19 testing guidance in late August. In a statement issued on August 27, the CAP said now is not the time to recommend halting COVID-19 tests for asymptomatic patients.

On August 24, the CDC revised its guidance to “focus on testing considerations” and removed previous statements recommending testing for asymptomatic individuals who have close contact to COVID-19 patients.

Contacts of those infected with the virus should continue to be tested because of the threat of asymptomatic or pre-symptomatic transmission, the CAP said. Similar statements were also issued by the American Medical Association and the Infectious Diseases Society of America. And, Democratic and Republican members of Congress have further denounced the revisions.

On August 27, CDC officials seemed to backtrack on their earlier statement, feeling pressure from the medical and scientific community. For instance, CDC Director Robert Redfield, MD, said in a statement that “all close contacts of confirmed or probable COVID-19 patients” should consider getting tested.

The CAP looks forward to serving on the HHS National Testing Implementation Forum where we will address the key issues of supply chain shortcomings involved in testing and guiding optimal testing for various settings, such as those involving symptomatic and asymptomatic individuals.

For the latest information on COVID-19 testing guidance, please refer to the CAP’s COVID-19 resources.

The CAP opposes new penalties that the HHS will impose on laboratories who do not meet the COVID-19 data reporting requirements. Despite the CAP’s repeated requests to clarify the reporting requirements, and provide a workable timeframe for implementation, the requirements remain unworkable for many laboratories.

The CAP called on HHS to rescind the new requirements, the threats of penalties, and reissue a clearer final laboratory data reporting regulation. Imposing these penalties when laboratory data requirements are ambiguous and impractical has greatly alarmed the laboratory medical community.

As previously stated in prior meetings with HHS officials, the agency needs to rescind the laboratory data reporting requirements and provide a flexible, phased-in approach to implement a complex reporting system. The HHS also fails to recognize that laboratory data infrastructure is not ready for these requirements.

The CAP is further disappointed that the regulation waives standard provisions in rulemaking, such as the 30-day delay in the effective date.

Additionally, the CAP updated its COVID-19 resources for laboratories on the current data reporting requirements for COVID-19 diagnostics with FAQs.

The CAP objected to UnitedHealthcare’s latest requirement that laboratories register most diagnostic tests and requested a meeting with the insurer to discuss the issue. The CAP stated its concerns in an August 26 letter, communicating that UnitedHealthcare’s request for additional information does not justify the added burden and stress of test registration, nor the deviation from consistent, uniform, national coding practice currently provided by the HIPAA-compliant and industry-standard CPT code set.

Starting on January 1, 2021, UnitedHealthcare claims for most laboratory test services must contain a laboratory’s unique test code for service. Moreover, each test code submitted on a claim must match a corresponding laboratory test registration provided in advance to UnitedHealthcare. These requirements are delayed from the original October 1 deadline in response to COVID-19, but this action does not go far enough.

The CAP requested “that UnitedHealthcare cease implementation of the claims submission requirements and work with us to address any information not currently provided by the standard American Medical Association (AMA) Current Procedural Terminology (CPT) code set,” as stated in the letter. The CAP further argued that the additional layer of coding requirements put forward by UnitedHealthcare would take significant time, resources, and education to implement, on top of the efficient and adequate CPT coding currently in use. “It is imperative that pathology practices and laboratories remain accessible across the country and that pathologists can focus on the essential task of testing and ensuring proper treatment of patients.”

The CAP will continue to update membership on the status of discussions with UnitedHealthcare. For more information on all of the CAP’s private sector advocacy, visit our webpage.

The CAP urged the Centers for Medicare & Medicaid Services (CMS) to provide fair reimbursement for COVID-19 diagnostic testing. Specifically, the CAP asked the CMS to reconsider their COVID-19 test prices and increase provider payment rates nationally. The CAP has advocated that pathologists and laboratories should be compensated fairly for this critical service for patients.

In an August 27 letter, the CAP highlighted how laboratories face unprecedented costs associated with the COVID-19 pandemic and laboratories cannot sustain these CMS underpayments. The CAP urged the CMS to issue a “national payment rate equivalent to the high-throughput test HCPCS codes (U0003 and U0004), based on the information we have received to date from a diverse cross-section of clinical laboratory providers. We believe that the CMS should also make the increased pricing update for CPT code 87635 retroactive to beginning from the date that CPT code was created and implemented, March 16, 2020,” the CAP said.

The CAP will continue to work with the CMS on this reimbursement issue.

Help the CAP by completing a short survey about how the COVID-19 pandemic has impacted your practice. Data from this survey is critical informing CAP leaders, policymakers, and government regulators of the economic and personal challenges that COVID-19 presented to pathologists.

Participants who complete the survey will receive a $5 Starbucks or Amazon.com gift card as a small token of our appreciation.

The CAP recognizes the value of your time, privacy, and your information will be treated as confidential and will not be associated with you or with your practice/group. The CAP appreciates pathologists for providing this feedback during these unprecedented times.

All CAP members should have received a survey invitation via email. However, if you haven’t received the invitation or cannot find the email, or if you have any other questions about the survey, please email practicesurvey@cap.org.

The CAP developed an exclusive Physician Fee Impact Calculator to help members evaluate their pathology practice's potential financial impact from the proposed 2021 Medicare Physician Fee schedule. The calculator can calculate an estimate for your practice if Congress does not act to stop planned Medicare cuts before Jan 1, 2021. Simply enter practice volumes to project estimated 2021 revenues and percent payment changes for all HCPCS/CPT codes, or a single CPT code based upon fees released in the proposed 2021 Medicare Physician Fee Schedule.

Although the CMS accepted the CAP’s recommendations on other changes, such as those for molecular interpretation services elsewhere in the fee schedule, the cuts due to the evaluation and management (E/M) services policy change will have a detrimental effect on pathologists' reimbursement. The exact impact of the overall 9% decrease in 2021 on an individual pathologist's reimbursement will depend on the physician’s case mix.

Check It Out

Take the new September News Quiz. Last month over 100 CAP members took the August news quiz. See how you compare against your fellow CAP members’ by taking this month’s quiz.

Take the September News Quiz

Due to the Labor Day holiday, Advocacy Update will take a scheduled break on September 8. You will receive the next edition of Advocacy Update in your email inbox on September 15. Please continue to check our Twitter, Facebook, and LinkedIn accounts for updates from the CAP.