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February 11, 2016
CMS Issues New Medicare Reimbursement Rates for 2016 Pathology Services
The Centers for Medicare & Medicaid Services (CMS) recently revised its 2016 Medicare Physician Fee Schedule and released a new conversion factor to calculate reimbursements for physician services. Technical revisions to Medicare fee schedule resulted in reimbursement adjustments, which included several changes to payment rates for pathology services.
The CAP updated its impact table for members to download. The impact table shows the effect of the latest 2016 reimbursement changes to pathology services compared to December 2015 reimbursements.
The 2016 fee schedule included several increases to pathology services sought by the CAP. Initiatives in the 2016 Medicare fee schedule resulted in an overall increase of 8% for pathology services, according to a CMS estimate. The estimate impacts overall payment to pathologists by a 4% increase based on changes to the work relative value units used to calculate the professional component of pathology services as well as the global payment. The impact on changes to the practice expense used to calculate the technical component as well as global payment resulted in a 4% increase in pathology payment.
The physician fee schedule payment received by independent laboratories was estimated to increase by 9% in 2016: A 1% increase is attributed to changes in the physician work values, and 7% is attributed to changes in the practice expense values (the CMS notes the total may not be equal to the sum of changes to physician work and practice expense values due to rounding). The impact upon an individual pathologist or practice would depend on the mix of services provided.
For the fourth quarter of 2015, the CMS set the conversion factor at $35.9335. In the 2016 fee schedule first published in November 2015, the CMS set the conversion factor at $35.8274. Since the 2016 final rule's publication, the CMS made technical revisions to several physician services. And, due to budget neutrality requirements, the conversion factor decreased by 0.07% to $35.8043.
Get the Latest Insights on National Elections at the 2016 Policy Meeting
Joining the lineup of political, policy, and pathology leaders at the 2016 CAP Policy Meeting is leading public opinion expert and NBC and Wall Street Journal pollster Peter Hart. Register today to hear from Hart and other experts at the 2016 Policy Meeting in Washington, DC May 2-4.
Mr. Hart's work has been key in determining the future for some of the most influential politicians in the country. As one of the top analysts in the United States, he is a leading expert on national trends and political messages. The National Journal recently named Hart as one of its 150 national leaders who shape federal government policy, lauding him as "probably the foremost Washington pollster for the Democratic Party and its centrist candidates."
Attend the 2016 Policy Meeting to hear from political experts like Hart and take action to advocate on behalf of the pathology specialty. On May 4, pathologists will meet with their senators and representatives in Congress during the CAP's annual Hill Day.
Haven't yet registered? Register for the CAP Policy Meeting today.
CAP 2016 Policy Meeting: Engage. Connect. Take Action.
White House Budget Plan Calls for Closing Medicare Self-Referral Loophole
President Obama's budget for fiscal year 2017 supports excluding anatomic pathology (AP) services from the In-Office Ancillary Services (IOAS) exception to the Stark Law. The president's budget reflects the CAP's advocacy to remove AP from the IOAS exception as self-referral as studies show this "loophole" leads to higher Medicare costs.
For his 2017 budget, as was the case in the two preceding budgets, the president again included striking AP in addition to advanced imaging, radiation therapy, and physical therapy services from the IOAS exception. Budget officials estimate removing these services would yield nearly $5 billion over 10 years in Medicare savings.
Even though the president supports closing the self-referral loophole, the budget only serves as a blueprint for Congress. Therefore, Congress would still need to pass legislation for the provision included in the budget to become law.
In a statement, the Alliance for Integrity in Medicare (AIM), for which the CAP is a member, said: "The AIM, a broad coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral, is extremely pleased that President Obama's FY 2017 Budget released today again recommends removing anatomic pathology, advanced diagnostic imaging, physical therapy, and radiation therapy from the physician self-referral law's IOAS exception. We applaud the Administration for demonstrating its support of Medicare beneficiaries by proposing to close the self-referral loophole for the fourth consecutive year."
In recent years, independent studies by the Government Accountability Office and research published in Health Affairs and the New England Journal of Medicine have shown that the self-referral increased utilization and Medicare spending. Patient advocacy groups, such as AARP and the Medicare Rights Center, also support removing these exceptions to the IOAS.