To assist pathologists as they exercise their medical expertise and judgment in the best interest of the patient by promoting and developing payment policies that allow the provision of high quality pathology services; and to facilitate pathologists' understanding of the payment policies and requirements of the government and other payers.
|Time Commitment Requirements|
|Number of face-to-face meetings||3|
|Length of meetings||1.5 days|
|Typical meeting days||Saturday and Sunday|
|Meeting locations||2 meetings take place in Washington, DC.|
|Number of conference calls||2-12|
|Hours/year of committee work required outside of meetings||Members 24-48+, Vice-Chair 24-48+, Chair and Workgrup Chairs 48-96+|
|Additional travel or time commitments||
Activities of Committee
- Maintains the CPT Coding Tutorial
- This Web-based course consists of fifteen coding vignettes and corresponding questions on a quarterly basis. The vignettes consist of multiple-choice answers and identification of and the rationale for the correct answer.
- Provides CPT coding roundtables at the CAP annual meeting.
- Provides webinars for the membership when there are significant changes in pathology performance measures and/or in pay-for-performance and related programs.
- Advocates for fair reimbursement policies at the Medicare local level by reviewing and commenting on LCDs and policy changes before they are implemented.
- Reviews and prepares recommendations for suggested payment levels for new clinical laboratory test codes each year. The CAP recommendations are presented by an EAC member at Medicare's annual Clinical Laboratory Fee Schedule public meeting.
- Reviews and provides recommendations for public comments on each proposed and final MEDICARE PHYSICIAN FEE SCHEDULE published annually.
- Conducts physician RBRVS surveys and makes recommendations for work relative value units and practice expense inputs for new and existing physician fee schedule codes to the AMA RUC. The EAC also reviews recommendations for the refinement of existing pathology services.
- Develops, maintains and manages the endorsement process of pathology-specific quality measures used by Medicare and other public and private payers in pay-for-reporting and value-based purchasing programs.
- Advocates for members on issues that arise under federal self-referral, anti-kickback, privacy and other applicable laws and regulations.
- Works to establish relationships in the private sector particularly with health plans to educate and achieve the most favorable treatment for pathologists on coverage and other policies and issues.
- Reviews proposed and implemented National Correct Coding Initiative (NCCI) edits and recommends advocacy efforts when appropriate. Recommendations include preparing response letters and coding proposals.
- Reviews recommendations for new or revised CPT codes and prepares and submits code change proposals when appropriate.
- Oversees CAP participation in the Pathology Coding Caucus (PCC). CAP Chairs and coordinates PCC recommendations to CPT.
- Reviews existing and potential new measures for the PQRS program and recommends potential changes.
- Includes evaluating the evidence base for candidate measures and any changes in the evidence base for existing measures as well as coding for measures and supporting the measure's endorsement before the National Quality Forum (NQF).
- Reviews existing and proposed regulatory schemes to judge the value of physician services’ for their appropriateness for pathology.
Expertise or Experience
- Interest or knowledge in pathology and laboratory CPT coding and payment systems; pathology-specific pathology metrics.
Benefits of Committee Membership
- The opportunity to contribute to CAP payment policy
- Represent the CAP to agency and liaison organizations
- Participate in presentations at educational conferences.
Representation on Committee Beyond the CAP
- CAP representative to AMA RUC,
- CAP alternate member to AMA RUC
- CAP advisor to AMA RUC, CAP advisor to AMA CPT
- CAP representative to AMA CPT's Pathology Coding Caucus
- Representative and alternate representative to the AMA's Physician Consortium for Performance Improvement (PCPI).