Home >> Tag Archives: Medicare/Medicaid (see also Physician fee schedule)

Tag Archives: Medicare/Medicaid (see also Physician fee schedule)

Medicare adopts new clinical consult billing codes

December 2021—Pathologists will have a new set of Current Procedural Terminology codes to use for reporting pathology clinical consultation services, beginning Jan. 1, 2022. These codes, which the CAP developed through its advocacy work with the American Medical Association CPT editorial panel, were published in the final 2022 Medicare physician fee schedule on Nov. 2.

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‘Scary situation’—lab leaders on staffing and COVID

October 2021—Surge, supplies, staffing. Eighteen months into the pandemic, the story remains similar. Even where laboratory salaries have been bumped up or sign-on bonuses have been in place to strengthen the workforce, Compass Group members report little to no success. And on supplies: “Every week we cross our fingers and toes to see what arrives in the door, how to disperse that through the systems, and how to continually educate the physicians on appropriate use of that limited resource,” says Judy Lyzak, MD, MBA, of Alverno Laboratories. She and other laboratory leaders of the Compass Group met virtually Sept. 6 to share their latest. Of the confluence of problems laboratories face, one said: “I have never seen anything quite like this.”

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Congress mitigates Medicare cuts at 11th hour

January 2021—Hanging over the publication of the 2021 Medicare physician fee schedule on Dec. 1 was an overall decrease of nine percent to pathology services and similar cuts to other specialty physicians. The Centers for Medicare and Medicaid Services in 2019 announced these payment cuts would offset increases to evaluation and management services, which are typically billed during physician office visits. The CAP through its advocacy opposed the cuts to pathologists and sought to stop them from taking effect.

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Millions at stake in ’21; CAP fights Medicare cuts

December 2019—Medicare reimbursement to pathologists in 2020 is estimated to remain steady, but significant cuts in payments to pathologists and other specialists are expected in 2021 owing to a dramatic shift in how primary care physicians will be paid. The CAP is already fighting the scheduled cuts to pathologists in 2021 as a result of a new plan that reimburses evaluation and management office visit services at a higher rate and lowers payments for non-E/M services billed by specialists.

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Up-front on PAMA impact, private payer pricing

September 2019—I’m going to talk about our experience over the past couple of years with PAMA, which seeks to produce market pricing, and some of the lessons we’ve learned. We all know how we got here and one of the questions has always been: Did we ever have market pricing? The answer is probably not. When you’re dependent on a 30-plus-year-old fee schedule that never was revised for technology revisions, there wasn’t market pricing to begin with. And at the end of all of what we’re experiencing, we still don’t quite have it.

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Higher pay for fibrinolysins interpretation in ’19 fee schedule

December 2018—The CMS finalized its 2019 Medicare physician fee schedule and its response to the CAP’s recommendations to raise payment for fibrinolysins interpretation and reporting and to forgo a proposed decrease to the physician work value for blood smear interpretation. The Centers for Medicare and Medicaid Services on Nov. 1 published the 2019 physician fee schedule. Services on the physician fee schedule are composed of three relative value units designated by the CMS: physician work, practice expense, and malpractice liability RVUs. Each RVU is separately valued and summed to equal the total RVU for each physician service on the fee schedule. The CAP advocates for the appropriate valuation of pathology services through its representation on the advisory committee of the AMA/Specialty Society Relative Value Scale Update Committee, known as RUC.

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Higher pay for therapeutic apheresis, bone marrow aspiration

December 2017—For 2018, CMS estimates a one percent overall decrease in pathology reimbursement. Pathologists will receive payment increases for therapeutic apheresis and diagnostic bone marrow aspiration services in 2018. At the same time, reimbursement for flow cytometry services will continue to decrease following phased-in reductions set by the Medicare program last year, but the CAP was successful in lessening the impact of cuts to those services in 2018.

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Market based? A view of PAMA process, pricing

September 2017—Under the Protecting Access to Medicare Act of 2014, Medicare rates for laboratory tests will be recalculated to reflect “market-based pricing” as reported by “applicable laboratories.” But are labs going to get a market-based price, or is the Centers for Medicare and Medicaid Services “gaming the system to ensure there will be a cut to the fee schedule”?

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For pathologists, 8% aggregate hike in Medicare pay

December 2015—The final Medicare physician fee schedule for 2016 delivered on the Centers for Medicare and Medicaid Services’ July proposal of an overall increase in payment for pathologists and independent laboratories. The agency also fulfilled some pathologists’ fears by cutting payments for prostate biopsy services by 19 percent for the technical component and 18 percent for the global payment.

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Pay is up in Medicare proposal, but final picture unknown

August 2015—After years of reading the latest news from the CMS with dread, pathologists and independent laboratories have some reason for revelry this summer as the agency’s proposed physician fee schedule offers an overall uptick in Medicare payment for 2016. Yet it is the final physician fee schedule, due in November, that will tell whether pathologists feel grateful toward the CMS when Thanksgiving rolls around.

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Labs entering risky payment game in the new year

January 2015—This year will bring a host of regulatory, coding, billing, and payment changes that are going to challenge pathologists and laboratory administrators to move quickly or else face declining revenue and the grim specter of Medicare recovery audits. That was the somber consensus of three experts gathered for a December webinar hosted by The Dark Report.

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CAP proposals on IHC, PQRS accepted for Medicare in ’15

November 2014—The Centers for Medicare and Medicaid Services on Oct. 31 published its 2015 Medicare physician fee schedule to set payment rates and policy for the next year, including the relative value units for existing and new Current Procedural Terminology codes. Several of the CAP’s recommendations and proposals were accepted for inclusion, such as three new quality measures designed for pathologists and eliminating G-codes to pay for immunohistochemistry services.

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Proposed prostate biopsy policy could cut Medicare pay

August 2014—How the Medicare program reimburses pathologists for prostate biopsy specimen services could change in 2015 under proposed rules for physician payment from the Centers for Medicare and Medicaid Services. The CMS detailed its proposed plans for prostate biopsy reimbursement, in addition to other payment policy changes concerning pathologists, in the proposed 2015 Medicare physician fee schedule released July 3. The proposal includes adding three new pathology measures, sponsored by the CAP, to the Medicare Physician Quality Reporting System and the expansion of CMS’ value-based modifier program. After a 60-day comment period, the CMS will finalize the 2015 fee schedule later this year.

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Protecting Access to Medicare Act
CAP on rule to implement law: ‘We will be there’

June 2014—The CAP’s leaders say they will keep pushing for favorable pathology payment policies as federal regulators implement new legislation that could lead to steep cuts in Medicare rates. Six weeks before the May 5–7 CAP Policy Meeting in Washington, DC, Congress enacted the Protecting Access to Medicare Act of 2014. The bill, signed into law April 1, stopped cuts to physician services under the flawed Medicare sustainable growth rate formula used to calculate Medicare pay.

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On cuts and consequences, pathologists make their case

October 2013—James Richard, DO, directs CAP-Lab, an independent laboratory in Lansing, Mich., where he manages the business and does everything from signing off on pathology reports to paying the mortgage on the building. But among the many issues he tackles running his practice and in the midst of a shift in health care in the U.S., a single rule proposed by the Centers for Medicare and Medicaid Services is what’s keeping him awake at night.

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MOC:PQRS incentive: what it is, how to earn it

September 2013—The Centers for Medicare and Medicaid Services has approved the American Board of Pathology for participation in the MOC:PQRS Additional Incentive Program. This approval allows ABP diplomates who are participating successfully in the PQRS incentive program to earn an additional 0.5 percent incentive payment on the total Medicare part B allowed charges for participating in MOC:PQRS in 2013.

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