Advocacy Update

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In This Issue:

Solutions provided by the CAP allowed pathologists to prevent a -5% penalty to their Medicare reimbursement in 2020. Based on quality reporting and other activities in 2018, the Centers for Medicare & Medicaid Services (CMS) reported that the vast majority of physicians and other clinicians eligible for Medicare’s Merit-based Incentive Payment System (MIPS) will not see their 2020 Medicare payments negatively adjusted.

For pathologists, the CAP’s quality measures were largely used to stop penalties that save pathology practices tens of millions of dollars annually. Also, for 2018, the CAP offered its Pathologists Quality Registry as a tool to stop the MIPS penalty and optimize reimbursement. The CAP further provided guidance to its members on, for example, which MIPS improvement activities were most likely relevant to their practices.

Key statistics reported by the CMS on January 6 are:

  • 98%, or about 872,150, of MIPS-eligible clinicians will receive a neutral or positive adjustment in 2020.
  • 5% negative adjustments will be levied on 2%, or about 17,800, of MIPS-eligible clinicians in 2020.
  • 1.68% is the maximum positive adjustment in 2020 for exceptional performance in MIPS. The positive payment adjustment is modest because, under statute, the positive and negative payment adjustments must be budget neutral. This means funds available for positive payment adjustments are limited to the estimated decrease in payments, according to the CMS.

The 2020 MIPS payment adjustments will be reflected on remittance advice documents for your Medicare Part B services. Share with your practice administrators that positive MIPS payment adjustments will be denoted by claim adjustment reasons code (CARC) “CARC 144” and remittance advice remark code (RARC) “RARC N807.” If you are being penalized, you will see “CARC 237” on the remittance advice.

If you need support on understanding these adjustments or have questions about using the Pathologists Quality Registry at your practice, contact the CAP’s experts at

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The CAP opposed a new Aetna reimbursement policy that would restrict payment for pathologists in Texas and urged the insurer to reconsider these changes. In a December 20 letter to Aetna of North Texas and Oklahoma, the CAP urged the insurer to reverse recent reimbursement policy changes for modifier-26 and continue payment for the professional component of clinical pathology. The CAP has requested a meeting to discuss this issue further.

As pathologists are the physician director of a clinical laboratory, the CAP outlined that if Aetna were to discontinue reimbursement for the professional component of clinical pathology services, the policy would prove detrimental to patients and to the integrated delivery of care to which laboratory diagnostic services are central, the letter said. The CAP further argued that the CMS already recognizes the significance of the services provided by the pathologist-director by including “the Part A payment Medicare makes to hospitals for each patient.” Therefore, cutting these payments would be inconsistent with the current CMS policy.

The CAP will provide updates in future newsletter articles.

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The Department of Justice (DOJ) examined the needs of forensic laboratories, medical examiners, and coroner offices. The recent study highlighted key issues the CAP has advocated for on behalf of forensic pathologists.

The DOJ Office of Justice Programs’ National Institute of Justice published the findings of a two-year study that examined the personnel, workload, and equipment needs of public crime laboratories, medical examiner, and coroner offices.

The report provides guidance and some solutions to address needs identified from stakeholders, including forensic pathologists. The report emphasized the importance of systems-based approaches involving coordination between forensic laboratories, law enforcement, legal professionals, and other effected parties.

Importantly, the report identified ways to address the challenges faced by forensic laboratories, such as sufficient and consistent funding, strategies to address staffing and personnel shortages, and activities to support the advancement of quality assurance programs.

The CAP has highlighted these areas as key issues for forensic pathologists and will push Congress to address the needs of the forensic science community legislatively.

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Members from the Texas Society of Pathologists will receive an exclusive update from the CAP on federal and state advocacy programs later this month. CAP President Patrick Godbey, MD, FCAP, will present at the Texas Society of Pathologists meeting on January 25.

Go to the Texas Society of Pathologists’ website to learn more about its 99th Annual Meeting in Plano, Texas January 24-26.

To strengthen the profession of pathology at the local level, the CAP supports state pathology societies to bolster advocacy efforts on issues such as private insurance, billing, and scope of practice. The CAP’s leaders also directly speak and visit with pathologists at several state pathology society meetings throughout the year.

Dr. Godbey’s presentation will review the CAP’s advocacy efforts to enact federal surprise billing legislation, protect the value of pathology services, and the upcoming Pathologists Leadership Summit, among other topics.

Check our state pathology societies webpage for more information about support the CAP provides to state societies.

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Already over 100 CAP members have registered for the 2020 Pathologists Leadership Summit. This is an exclusive opportunity for CAP members to elevate leadership skills, take action, and be more effective advocates for positive change—particularly now that the Spring House of Delegates Meeting and our annual Hill Day are also part of this event.

The Pathologists Leadership Summit will help you better manage your practice, achieve greater influence, and establish and maintain relationships with the legislators who make decisions that affect your specialty.

There is no fee to attend this event, and it includes CME credits. The Pathologists Leadership Summit will give you exclusive access to unparalleled education, training, and brainstorming sessions with key CAP leaders to inspire the leader within you.

Visit for more information and help us set the path to a better future and register today.

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Check out January’s advocacy news quiz and join hundreds of your fellow CAP members to test your advocacy knowledge. Try sharing your results on social media to see who has the highest score. Take the quiz today.

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