In a pre-Thanksgiving surprise, the Centers for Medicare and Medicaid Services (CMS) announced that it would not finalize a proposal to cap reimbursement for certain pathology services furnished by independent labs and in physician offices at hospital outpatient payment rates. Lab and pathology groups applauded the announcement, contained in the final Medicare Physician Fee Schedule (PFS) rule for 2014. The rule was issued Nov. 27, the day before Thanksgiving. CMS elected not to finalize the proposal and instead said it will consider more fully all comments received and plans to develop an alternate proposal for using outpatient and ambulatory surgical center rates in developing relative value units. CMS’s stated goal is to bring payment for lab services provided in nonfacility settings more in line with services provided in facility settings. The proposal, which was contained in the proposed PFS rule issued in July, would have reduced reimbursement to independent laboratories by an estimated 26 percent. Some common anatomic pathology (AP) codes would have seen reimbursement cut by as much as 80 percent. Congressional pressure to abandon the proposal likely contributed to CMS’s decision. A total of 115 representatives and more than 40 senators signed on to a letter sent to […]
In a pre-Thanksgiving surprise, the Centers for Medicare and Medicaid Services (CMS) announced that it would not finalize a proposal to cap reimbursement for certain pathology services furnished by independent labs and in physician offices at hospital outpatient payment rates.
Lab and pathology groups applauded the announcement, contained in the final Medicare Physician Fee Schedule (PFS) rule for 2014. The rule was issued Nov. 27, the day before Thanksgiving.
CMS elected not to finalize the proposal and instead said it will consider more fully all comments received and plans to develop an alternate proposal for using outpatient and ambulatory surgical center rates in developing relative value units. CMS’s stated goal is to bring payment for lab services provided in nonfacility settings more in line with services provided in facility settings.
The proposal, which was contained in the proposed PFS rule issued in July, would have reduced reimbursement to independent laboratories by an estimated 26 percent. Some common anatomic pathology (AP) codes would have seen reimbursement cut by as much as 80 percent.
Congressional pressure to abandon the proposal likely contributed to CMS’s decision. A total of 115 representatives and more than 40 senators signed on to a letter sent to CMS Administrator Marilyn Tavenner opposing the cuts.
The American Clinical Laboratory Association commended CMS for not finalizing the proposal to “slash Medicare payments for anatomic pathology services which diagnose breast, colon, prostate, skin, ovarian, leukemia, and other cancers.
The College of American Pathologists said it remains opposed to efforts to cap AP payment at facility rates and “will consult with coalition partners and Congressional supporters on both sides of the aisle on the next steps to prevent future implementation of this or similar proposals that do not accurately account for the cost of delivering laboratory services.”
