Federal
CMS Publishes Final Physician Fee Schedule; Revises Pathology Anti-Markup Rule, TC Grandfather Provision
The Centers for Medicare and Medicaid Services (CMS) recently published its final rule on the 2009 Physician Fee Schedule. The rule revises the anti-markup rule for the professional (PC) and technical (TC) components of anatomic pathology services (the “anti-pod lab rules”) and extends the TC grandfathering provisions. Also, per Congress’s actions in July the PFS will receive a 0.5 percent increase in reimbursement rates for 2009, reversing the 10.6 percent cut in reimbursement rates that would have otherwise occurred (Click here for details).
As part of the PFS final rule, CMS modified the anti-markup rule but did not follow ASCP’s recommendations for a rigorous, more comprehensive anti-markup rule. ASCP believes the new rule is not sufficiently robust and will continue to press the agency to revise the rule in line with the Society’s recommendations.
The final rule utilizes a two test approach to determine if the anti-markup rule is applicable. First, if the performing physician (the physician either performing the professional component of the anatomic pathology service or supervising the technical component) performs at least 75 percent of his or her professional services for the billing physician or supplier, then the anti-markup provisions do not apply to the professional or technical components. If, however, the performing physician can not satisfy this requirement then the billing physician would have to meet the second test. This second test would apply the anti-markup rule except when the TC is conducted and supervised and the PC is performed in the office of the billing physician or supplier by an employee or independent contractor.
In addition, the rule provides for 2009 a positive 4.5 percent update to the Clinical Laboratory Fee Schedule (CLFS), this fee schedule’s first increase in almost 10 years. (Click here for details). This update factors in a negative adjustment to the CLFS of 0.5 percent, as mandated by this year’s Medicare bill. This negative adjustment will apply each year from 2009 through 2013.
The TC grandfathering extension allows certain qualified independent laboratories to continue to bill Medicare contractors for the TC of a physician pathology service furnished to a hospital patient. To continue to bill Medicare for these services, an independent laboratory must have had an arrangement with a hospital as of July 22, 1999 under which that laboratory furnished the TC of the physician pathology service to a hospital patient. The extension is scheduled to expire on December 31, 2009 if it is not extended.
Click here to access a copy of CMS’ final rule revising the Physician Fee Schedule for calendar year 2009.
Congress
Health Care Reform Is A Top Priority for 2009
Baucus, Kennedy and Daschle to Be in Key Roles
Health care system reform will be a top domestic priority for the 111th Congress and the incoming Obama Administration. Leading the efforts for the new Administration will be former Senator Tom Daschle as President-elect Obama’s new Secretary for Health and Human Services. Daschle, who has been serving as the head of Obama's health care advisory team, recently released a new book Critical: What We Can Do About the Health-Care Crisis. The book calls for health care reform in the United States and examines the failure of past efforts.
Leading the charge in Congress will be Senators Max Baucus and Ted Kennedy. Senator Baucus, the Chair of the Senate Finance Committee, recently issued an eighty-nine page blueprint for health care reform and Senator Kennedy and his staff on the Senate Health, Education, Labor and Pensions Committee are preparing a legacy package that they expect to complete in the coming weeks.
In addition to the Baucus and Kennedy proposals, ideas and legislation are also expected from leaders of key committees within the House of Representatives (e.g., House Ways & Means Committee and House Energy and Commerce Committee).
The American Society for Clinical Pathology has identified health care reform as a top priority for the organization. ASCP will review and develop analyses of legislative proposals and work with the pathology and laboratory medicine community to ensure that our nation’s patients have access to efficient high-quality pathology and laboratory medicine services.
State News
FL Lab Board Adopts ASCP Recommendations on Molecular Practice
On November 14th the Florida Board of Clinical Laboratory Personnel adopted ASCP’s recommendations for addressing a regulatory issue that would have required all individuals performing molecular testing to be licensed by the Board in the specialty of molecular pathology. Florida Board staff had determined that even individuals licensed by the Board in other specialties, such as blood banking or microbiology, would have to be licensed in molecular pathology to perform "molecular detection techniques" within their licensed scope of practice.
In a letter to the Board, ASCP disagreed with the Board’s interpretation of the statute and rules that individuals licensed by the Board in other specialties had to be licensed in molecular pathology to perform molecular testing in their licensed scopes of practice. ASCP reiterated these points in a statement provided to the board by ASCP member Marian Cavagnaro, MS, MT(ASCP)DLM.
The Board decided that it would need to revise the rule. However, in the interim the Board clarified its interpretation of its rule in line with ASCP’s recommendations, adopting ASCP’s proposed language for this clarification. The Board indicated it was not its intent to limit molecular testing to a particular specialty. The clarification will allow a person licensed by the Board to perform molecular testing in their licensed scope of practice provided they meet existing regulatory requirements on training or experience. ASCP will be monitoring the Board’s rule revision to ensure it is consistent with the Society’s recommendations.
Ohio Advocates Push for Direct Billing
Pending State Legislation to Protect Ohio Patients
ASCP recently called upon its members in Ohio to write their state senators in support of direct billing legislation for anatomical pathology services. HB 493 will protect Ohio patients against inappropriate billing practices by prohibiting an ordering physician from billing patients for anatomic pathology services performed or supervised by another physician.
ASCP has long been a proponent of direct billing, believing it to be a resource to avert the adverse impact markups have on the state’s health care system and the potential for profit by marking up test charges which can distort medical decision-making, cause over-utilization, increase costs and result in unfair competition. It can also adversely affect patient care. To date 14 other states have laws requiring direct billing for anatomic pathology services.
Society News
ADVOCACY 101: Article Highlights Step by Step Process for Legislative, Regulatory Change
In next month’s Critical Values, ASCP’s Washington Office has provided a blueprint of how to communicate with legislators and regulators on an identified public policy issue. The template examines what the American Society for Clinical Pathology (ASCP) has identified as an important issue to the field – the laboratory workforce shortage. The “how-to” is divided into phases covering the education of the targeted elected officials and advocates. In addition, the article outlines the strategy of the campaign, what should be done to alleviate the problem. The primer also provides examples of the tangible tools needed to carry out the suggested strategy. In future editions of e-Policy, there will be a continued focus on the practical application of advocacy to achieve success on the public policy front.