CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
The CAP disagreed and advocated for the exception to continue to apply to molecular pathology tests, highlighting that the tests are still not commonly performed by hospitals, as they are not always practical or cost-effective due to lower test volumes.
In another date-of-service proposal, the CAP worked with the AABB to urge the CMS to finalize a date-of-service proposal for laboratory testing. In the final Hospital Outpatient Payment System regulation, the CMS decided that the date on which blood banks perform the laboratory test on specimens collected during a hospital outpatient encounter will be the date of specimen collection. As a result, the hospital will bill Medicare for the laboratory test, and the blood bank performing the test would seek payment from the hospital.
The CMS also agreed to define a blood bank as an entity whose primary function is the performance or responsibility for the performance of the collection, processing, testing, storage, and/or distribution of blood or blood components intended for transfusion or transplantation.
Outpatient payment for 88307. After threatening another cut, the CMS retained its payment assignment for the surgical pathology code 88307 in the Hospital Outpatient Payment System. Initially, the CMS had proposed lowering the hospital ambulatory payment classification for 88307 by 46 percent. After considering the CAP’s comment and analysis of the updated claims data for the final rule, the CMS decided to maintain the ambulatory payment classification assignment for 88307 in 2020.
MIPS scoring tougher in 2020. For pathologists participating in Medicare’s Merit-based Incentive Payment System in 2020, the CMS increased its performance threshold to 45 points, from 30 points in 2019, to avoid a payment penalty. MIPS scores based on 2020 performance will affect Medicare reimbursement in 2022. MIPS-eligible physicians who score fewer than 45 points in 2020 will receive a nine percent payment cut in 2022. The CMS detailed these changes Nov. 1 in a regulation for its Quality Payment Program, which includes MIPS.
The CMS had sought to remove four pathology quality measures, but the CAP demonstrated the need for more appropriate measures for pathologist participation in MIPS. As a result, the CMS retained the four pathology measures that otherwise would have been removed and added a dermatopathology measure to the pathology measures set.
Starting in 2019, Medicare Part B claims measures could only be submitted via claims by pathologists in a small practice (15 or fewer eligible clinicians) and can be submitted with individual or group participation. Pathologists in a group of 16 or more can no longer submit quality measures using claims, regardless of whether participating as an individual or group, and must submit using a qualified registry or qualified clinical data registry. These rules will again be in effect for 2020. The CAP’s Pathologists Quality Registry is a tool that provides both reporting options for MIPS-eligible pathologists, practicing in either small or large practices, to meet MIPS requirements.
Pathology values. The CAP advocates for the appropriate valuation of pathology services as the pathology representative on the RUC advisory committee. The AMA RUC is an expert panel that uses its independent judgment to assist specialties in appropriately valuing their work. It provides physicians with a voice to shape how they are paid for their services, and the CAP participates in the RUC process to advocate for appropriate payment of pathology services.
CAP members can participate directly in the RUC process by participating in the CAP’s RUC survey process. These surveys assist the CAP in assessing the time, intensity, complexity, and ultimate value of pathologists’ work. The CAP’s advocacy staff conducts periodic physician work surveys to gather data used to advance the specialty and to accurately account for the pathologists’ work efforts. These surveys may be associated with new, revised, or potentially misvalued pathology services in need of valuation or revaluation.
Pathologists chosen for a physician work survey receive an email requesting completion of a 10- to 15-minute online survey. CAP members are encouraged to take all AMA RUC physician work surveys and to be honest about the typical time and work spent on an individual service.
A July 2017 Advances in Anatomic Pathology article, “Current valuation of pathology service,” coauthored by Jonathan L. Myles, MD, who served previously as the CAP’s member on the AMA RUC advisory committee and is now a member of the CAP Board of Governors, explains how pathology services are valued and notes that the work RVU component represents a “physician’s time to perform the service, the technical skill and physical effort, the required mental effort, and judgement, as well as the stress due to potential risk to the patient” (Myles JL, et al. 24[4]:222–225).
Charles Fiegl is the CAP’s director for advocacy communications, Washington, DC.