ASCP Calls for Elimination of Stark Pathology Exemption

As part of its comments on two recently proposed rules affecting the Stark self-referral, anti-markup, and civil monetary penalty regulations, ASCP urged the Centers for Medicare and Medicaid Services (CMS) to eliminate the In-Office Ancillary Services (IOAS) exception. The IOAS exception allows referring physicians to bill for, and profit from, the anatomic pathology services they order on their patients. The two rules were issued by CMS and the U.S. Department of Health and Human Services Office of the Inspector General (OIG). Studies, including several by the OIG and the Government Accountability Office, have shown that clinicians order more anatomic pathology service when they can profit on their referrals. This increases the costs to patients and insurers with no added benefit in quality.

The self-referral of anatomic pathology services has also had another impact on pathology. In response to increased utilization of CPT code 88305, CMS has markedly decreased reimbursement for the technical component of this services. Between the years of 2012 and 2019, Medicare reimbursement dropped from $69.78 to $30.63—a 56-percent decrease. Many private payers have adopted sizeable cuts to this service as well. Because of concerns about overutilization, cost and the impact on patients, ASCP has advocated for eliminating anatomic pathology from the Stark IOAS exception.

In the two proposed rules, CMS and OIG proposed relaxing several of the self-referral, anti-mark-up and civil monetary penalty regulations to provide increased flexibility to providers participating in value-based arrangements. While ASCP outlined its support for increasing participation in value-based care models, the Society strongly urged the Agency to remain focused on the problem of self-referral. ASCP recommended that to better incentivize provider participation on value-based care models, the Agency should remove anatomic pathology services from the IOAS exception in non-value-based care settings. Otherwise, leaving the IOAS as is provides strong financial incentives for providers not to participate in the Agency’s value-based care models.

Other articles in the January 2020 ePolicy News:

Congress Delivers Key Legislative Victory
CMS Should Expand NGS Coverage, ASCP Urges
ASCP Supports Opioid Workforce Act

To read more articles from ePolicy News click here.

For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.