Advocacy Update

Read the Latest Issue of Advocacy Update

July 16, 2019

In This Issue:

Following a House subcommittee hearing on legislation to address surprise medical bills, the CAP opposed HR 3630, the No Surprises Act, due to a reimbursement benchmark requirement that relies on insurance industry-controlled median contracted rates to pay for out-of-network services.

After the House Energy and Commerce Subcommittee on Health marked up HR 3630 on July 11, the CAP urged the full Energy and Commerce Committee to amend the bill by eliminating its rate-setting reimbursement provision and replace it with an independent dispute resolution process. The current bill fails to include an independent dispute resolution process that’s successfully proven to keep patients from receiving surprise medical bills in several states.

The CAP and other physician specialty associations have warned that HR 3630’s reliance on rate setting for out-of-network services would create imbalance and threaten patient access in the US health care system.

The root cause of a surprise medical bill is a health insurance plan with an insufficient provider network. Independent arbitration systems work by financially protecting patients and reducing out-of-network costs. In addition to arbitration, the CAP asks Congress to require network adequacy standards for health insurers as part of the holistic solution to address the problem of surprise billing.

Speak Out on Surprise Medical Bills

The CAP has urged all pathologists to contact their representatives and ask them to cosponsor the Protecting People from Surprise Bills Act, HR 3502, which has been introduced by Rep. Raul Ruiz, MD (D-CA) and Rep. Phil Roe, MD (R-TN). CAP members can easily communicate with Congress on this important issue through our grassroots action network, PathNET, which is available for you to contact your federal legislators. More than 1,200 CAP members have contacted their federal representatives over 8,300 times on this imperative issue.

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Periodically Advocacy Update features a CAP member who is a champion for pathology in Washington and at the state level through our grassroots and PAC programs. Recently Advocacy Update caught up with Richard R. Gomez, MD, FCAP, who is CAP Secretary-Treasurer as well as a staff pathologist at the University of Kansas Health System-St Francis Campus in Topeka, Kansas.

Why should your colleagues get involved in advocacy?

Many decisions that have an impact on our patients and our practices are made in Washington, DC. Being involved in advocacy enables us to develop important relationships with our federal representatives and their staff. Once these relationships are established, having conversations with members of Congress on health care issues becomes easier and you have access to their staff and the Congressional members.

What advice would you give to someone who wants to be involved in advocacy?

There are many ways to get involved. A great first step is to attend the CAP Spring Meeting in 2020, where the CAP reviews the key advocacy issues that affect pathologists and have a guided Hill day where you can visit the offices of your federal legislators. You can also attend district fundraisers for your congressional members when they visit their home districts. You can also schedule a laboratory tour with your federal legislators, which not only is an opportunity for you to build a relationship with your member of Congress and/or their staff, but also a way to advocate for pathology.

Do you have a favorite memory or experience that stands out in your advocacy work?

I have had the privilege to attend several fundraisers for both representatives and senators from Kansas and have a special relationship with Sen. Jerry Moran (R-KS). Each time I see Sen. Moran, he addresses me as Dr. Gomez, and we discuss health care issues that I bring up. Because of our relationship, he often ends our conversations by asking me what are the CAP’s top advocacy priorities and asked how he can help to support those initiatives. Moreover, he also asks what the effects of a legislative bill would have on rural health care in Kansas.

If you would like to get involved, you can join PathNET, contribute to PathPAC, or join your state pathology society.

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The Centers for Medicare & Medicaid Services (CMS) announced it initiated audits of physicians’ data submissions under the Merit-based Incentive Payment System (MIPS). This audit of 2017 and 2018 data submissions seeks to ensure the MIPS program is operating as intended and providers are complying with CMS requirements. 

The CAP routinely provides updates to its members on the MIPS program and has several educational resources available under the MIPS for Pathologists section of If you have questions about MIPS or the CMS’ audit, contact our experts by emailing

If selected for an audit, you will receive a request for information from Guidehouse, the CMS auditing vendor, by email or certified mail. You will have 45 calendar days from the date of the notice to respond with the requested information.

Please note, if you do not provide the requested information, the CMS may take further adverse action. Additional information about the audit and validation criteria can be found on the CMS website: 

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As reported in the July 2 issue, eligible pathologists who submitted 2018 MIPS data through the Quality Payment Program (QPP) website, can now view their performance feedback and MIPS final score. Your 2018 MIPS performance will determine payment adjustments to your Medicare Part B payments in 2020 of +/- 5%. The CAP encourages all MIPS eligible pathologists to log in and review their preliminary MIPS 2018 scores soon to make sure they are correct. Preliminary MIPS feedback reports suggest that a MIPS score of 100% resulted in the maximum positive payment adjustment of 1.68%, which includes the exceptional performance bonus.

MIPS is a budget-neutral program, meaning that the money from negative adjustments obtained from poor performers are redistributed as positive adjustments to high performers. Presumably, due to the majority of MIPS clinicians performing very well in the program in 2018, the positive payment adjustments are not the highest +5% but rather modest. The exceptional performance bonus is not budget neutral, but rather from a separate pool of $500 million available to those MIPS clinicians and groups who performed above the Performance Threshold of 70 points.

Individual pathologists can access their 2018 MIPS scores by logging in to the QPP web site with their QPP login credentials.

Pathologists Participating in MIPS Alternative Payment Models (APM)

Pathologists who participated in one of the models below in 2018, your MIPS performance feedback is now available via the Quality Payment Program website:

  • Medicare Shared Savings Program Accountable Care Organization (ACO)
  • Next Generation ACO
  • Comprehensive Primary Care Plus
  • Oncology Care Model
  • Comprehensive ESRD Care

For pathologists who practice in an APM, the MIPS AMP score will be an APM score and applies to all MIPS eligible clinicians within the APM entity.

Targeted Review

If you do have concerns about your preliminary score, the CMS asks physicians to request a targeted review. Pathologists can request a targeted review until September 30, 2019. 

For more information, please refer to the 2018 Performance Feedback FAQs, 2018 Targeted Review Fact Sheet, the 2018 Targeted Review FAQs, and the QPP Access User Guide or email CAP MIPS experts at

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Navigating the requirements to comply with MIPS successfully can be confusing, especially for non-patient facing clinicians such as pathologists. As part of our ongoing commitment to ensure pathologists can successfully participate in new and evolving payment models, the CAP has a MIPS webinar series.

The CAP MIPS webinar series offers a comprehensive education program specifically developed for pathologists to help answers questions about 2019 MIPS reporting options and the new requirements. Upon completing this five-part webinar series, you will fully understand program requirements, be able to optimize your participation, and successfully comply with MIPS.

Click here for the MIPS webinar series.

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Due to a delay in the CMS’ release of the proposed updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations, the CAP rescheduled its webinar to Tuesday, July 30 at 1 PM ET/ Noon CT. Please update your calendars.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Donald S. Karcher, MD, FCAP; Vice-Chair of the Council on Government and Professional Affairs and Chair of the Clinical Data Registry Ad-Hoc Committee Emily E. Volk, MD, FCAP; and Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP.

During the 60-minute webinar, attendees will learn about updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations and its impact on pathologists. The CAP panel will also answer questions from attendees.

If you are unable to attend the live event, a link to view an archived recording of the presentation will be sent to all registrants following the webinar. The recording can be viewed at your convenience.

We appreciate your flexibility and look forward to your participation during the webinar on July 30.

Register today for the webinar.

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Join over 100 of your fellow CAP members and test your advocacy knowledge with the new July Advocacy News Quiz. Of those members who took the quiz, they scored an average of 80%. See how you measure up against your fellow pathologists on this month’s quiz and share your results. Good luck!

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