Advocacy Update

• CAP Praises Congress for Introducing the Supporting Medicare Providers Act of 2022
• Don’t Miss These CAP Advocacy Sessions at the Annual Meeting
• CAP Reviewing Agency Request for Information on Advanced Explanation of Benefits
• Test Your Advocacy News Intelligence
• Breaking Advocacy News: Check out the Advocacy Twitter Channel

On September 13, House Reps. Ami Bera, MD (D-CA), and Larry Bucshon, MD, (R-IN) introduced bipartisan legislation that would alleviate Medicare cuts for all physicians. The Supporting Medicare Providers Act of 2022 (HR 8800) aims to lessen the upcoming Medicare reimbursement cuts in 2023 and provides guidance to improve the Medicare Payment system for physicians. The CAP has urged that Congress take action to mitigate Medicare reimbursement cuts, while preserving critical physician services for Medicare patients.

In a statement from CAP President Emily E. Volk, MD, FCAP she stated support for the bill.

“The CAP commends Reps. Ami Bera, MD, and Larry Bucshon, MD, for their leadership to introduce the Supporting Medicare Providers Act of 2022, which will mitigate reimbursement cuts and preserve access to physician services for Medicare beneficiaries,” Dr. Volk said. “Physicians are once again facing sharp decreases to the Medicare services they provide to our nation’s seniors in just a few short months. The economic relief offered in this new piece of legislation comes at a time when margins are extremely thin as inflationary pressures have increased costs in all sectors of the economy, including health care and physician practices. Future cuts to Medicare reimbursement will only threaten the ability for some practices to stay open if rising costs exceed revenue. At the same time, pathologists continue to meet huge demands for COVID testing and encounter new challenges like monkeypox or rising cases of polio, while still providing patients and their treating physicians with the diagnoses they need to treat other diseases.”

Are you interested in finding out how the CAP is working for you every day? Join us at our advocacy sessions during the CAP22, October 8-11 in New Orleans, where we discuss current issues of importance to pathologists and how the college is addressing them. This is also your chance to give us feedback on issues that matter to you.

Mark these advocacy sessions on your calendar (all sessions are in-person unless indicated otherwise):

• Saturday, October 8, 12:00-1:00 p.m. PathPAC Sponsored Lunch with keynote by Amy Walter
• Sunday, October 9, 7:30-8:30 a.m. How Many Pathologists Do We Really Have in the U.S.? Opportunities and Implications for Future Practice, presented by W. Stephen Black-Schaffer, MD, FCAP; Kalisha A. Hill, MD, MBA, FCAP; and Thomas M. Wheeler, MD, FCAP (A2261)
• Sunday, October 9, 9:30-10:30 a.m. How Is My Payment Determined for Pathology Services? Presented by Jonathan L. Myles, MD, FCAP, and Mark S. Synovec, MD, FCAP (M2171)
• Sunday, October 9, 2:30-3:30 p.m. CPT Coding … You Can’t Practice Without It! Why Pathologists Need to Understand Coding, presented by Mark S. Synovec, MD, FCAP (A2276)
• Sunday, October 9, 7:30-9:00 p.m. PathPAC Thank-You Reception
• Monday, October 10, 11 a.m.-12:30 p.m. Advocacy Town Hall, moderated by Kalisha Hill, MD, FCAP, with CAP President Emily Volk, MD, FCAP, and Jonathan L. Myles, MD, FCAP; and (in person and live stream) (A2260)
• Tuesday, October 11, 11 a.m.-12:00 p.m. Current Payment Policy Challenges in Pathology Practice, presented by Jonathan L. Myles, MD, FCAP (A2275)
• Tuesday, October 11, 7:30-8:30 a.m. Demonstrating Your Value and Protecting Your Reimbursement in Evolving Quality Payment Models, presented by Diana M. Cardona, MD, FCAP (M2177)

Annual meeting registration information is available at https://www.capannualmeeting.org/.

See you in New Orleans!

On September 16, the Department of Labor, Department of Health and Human Services (HHS), and the Treasury released a request for information (RFI) that will inform future rulemaking for the advanced explanation of benefits and additional good faith estimate (GFE) requirements of the No Surprises Act. Unlike the current GFE requirements for self-pay/uninsured patients, the upcoming rulemaking will implement requirements that where an individual has health insurance and is seeking to have a claim for such item/service submitted their insurer, providers/facilities must provide to the insurer a GFE of the expected charges. This information will then be used by the insurer to send to the patient an advanced explanation of benefits.

The CAP has continually stressed the significant – and particular – difficulty in determining the cost of pathology services in advance of services conducted by the pathologist and will be submitting comments to the departments by the November 15 deadline.

Reminder: Good Faith Estimates Resources Available for Pathologists

Beginning in 2022, the Centers for Medicare & Medicaid Services (CMS) implemented good faith estimate requirements for physician and other provider practices.

Specifically for pathologists, these requirements mandate that a good faith estimate of expected charges be provided to uninsured or self-pay patients at least three business days before a scheduled service or upon request. This must include expected charges for the items or services provided in conjunction with the primary item or service. A good faith estimate is not required to include charges for unanticipated items or services that are not reasonably expected and that could occur due to unforeseen events.

The CAP has resources to help members understand the good faith estimates and price transparency for diagnostic medicine, including a toolkit and a podcast.

Think you know CAP Advocacy? Why don’t you test it with the September Advocacy News Quiz. Last month almost 100 members took the quiz. See how you compare against your fellow CAP members and brag about your top scores on social!

Take the news quiz

Want up to the minute CAP Advocacy news? Then follow us on twitter at CAPDCAdvocacy, where you will be the first to know about CAP Advocacy wins, see your fellow members engage with Congressional leaders on key policies affecting the practice of pathology and, of course, breaking Advocacy news.

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