Both the CAP and ASCP have recently written letters to CMS, urging it to reconsider its decisions to slash 88305 reimbursement and to place molecular pathology codes on the Clinical Laboratory Fee Schedule (CLFS) and not the Physician Fee Schedule (PFS). I very much appreciate the fact both organizations are continuing to advocate for better treatment from CMS.
Both organizations have summarized the content of their letters-ASCP in its January 2013 ePolicy News and CAP in its most recent STATLINE. I will post the full letters at the bottom of the post for those interested. They both do a very nice job of explaining what all went in to CMS’s decisions, and why those decisions are suboptimal from an organized pathology perspective.
Although the letters are certainly similar in content, they diverge enough to make reading both worthwhile.
Here are some of the more interesting points:
-CMS essentially blind-sided the profession of pathology by announcing the 88305 reimbursement cut in its final rule and not its proposed rule, thereby precluding stakeholders from submitting public comments
-CMS erroneously rejected multiple recommendations from the Resource-based Relative Value Scale Utilization Committee (RUC) related to direct practice expenses, including costs for specimen, solvent, and formalin disposal (CMS recognizes the cost of the actual solvents, but not their disposal); courier transportation; equipment maintenance cost; computer system and maintenance contract; and software
-CMS should phase the reimbursement cuts in over at least a three year period
-CoPath costs between $120,000-$150,000, is unique to the practice of anatomic pathology, and should be included in the direct practice expense inputs for the 88300-88309 codes
-The CAP, with the help of four other professional organizations, looked at 411 88305 cases and found the median number of blocks needed was 4. (Two of the organizations were dermatopathology-related, so no doubt there were a lot of multi-block skin excision cases)
-The placement of molecular codes on the CLFS will hurt patient care, as fewer pathologists will go into molecular pathology
-There is no review process for tests on the CLFS, meaning the value of molecular tests will not be adjusted
-The MolDx program created by Palmetto GBA to “modify coverage and reimbursement policies for certain molecular diagnostic laboratory tests” violates HIPAA, exceeds Palmetto’s authority and should be stopped immediately