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Following the 2015 CAP Policy Meeting, the College will continue to advocate for reforms to Medicare's Local Coverage Determination (LCD) process in order to increase transparency and ensure decisions are made by qualified experts and based on sound medical evidence.

CAP members spoke with their elected officials about improving the LCD process during the May 4-6 Policy Meeting. Members called on Congress to introduce legislation that ensures that medical and scientific evidence in LCDs is used in a transparent and meaningful process from start to finish rather than selectively to deny appropriate coverage of services to Medicare beneficiaries. Reforms are necessary to ensure that LCDs do not impede a physician's medical judgment and deny patients access to medically necessary care.

View the CAP's draft legislation. The CAP in an issue brief detailed the following changes to the LCD process that will improve transparency and boost accountability.

  1. Open Meetings: The CAP is asking that a Medicare Administrative Contractor's (MAC) carrier advisory committee meetings be open, public, and on the record. Minutes should be taken and posted to the MAC's website for public inspection.
  2. Upfront Disclosure: The CAP is asking that MACs include—at the outset of the process—a description of the evidence the MAC considered when drafting an LCD as well as the rationale they are relying on to deny coverage. If this information is not provided until the final LCD, as proposed under the 21st Century Cures draft legislation, it hinders meaningful stakeholder exchange and can make a MAC's decision to deny coverage a fait accompli.
  3. Meaningful Reconsideration and Options for Appeal: Under current Centers for Medicare & Medicaid (CMS) rules, MAC LCDs are essentially unreviewable once they become final. In order to have an LCD reconsidered, you have to present new evidence to the MAC that issued the LCD. The CAP recommends the new evidence requirement be removed and also recommends that reconsideration requests include the option of making an appeal to an uninterested body such as a CMS regional office, or the CMS Administrator.
  4. Stopping the Abuse of LCDs as a backdoor to National Coverage Decisions (NCDs): Congress should prohibit the CMS from appointing a single MAC, either expressly or in practice, from making determinations to be used on a nationwide basis in a given specialty.

More news and information on this issue will be reported in future editions of STATLINE.

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The Medicare agency has extended a deadline to apply to participate in end-to-end testing of the ICD-10 diagnosis coding set in July. The CMS is encouraging physicians to volunteer and submit an application by May 22.

All physicians and Health Insurance Portability and Accountability Act (HIPAA)-covered entities must use ICD-10 codes starting with services provided on October 1. The CAP has several resources available on the transition to ICD-10 under "International Classification of Diseases (ICD)" subhead in the Practice Management section.

The CMS will accept applications from May 11-22. The final testing week will occur the week of July 20-24 during which time providers selected will have a chance to test sample claims using ICD-10 codes with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing, the CMS said.

Volunteer forms are available on your MAC website and are due May 22. The CMS will review applications and select providers for the July test period. The MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing by June 12.

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In a new series of short videos for CAP members, the College reviewed Medicare reimbursement changes in the 2015 fee schedule and other advocacy issues affecting pathologists. The video briefings on Medicare changes to immunohistochemistry, in situ hybridization, and prostate biopsy services are now available to view on your computer, smartphone, or tablet device, and share with your colleagues.

CAP Economic Affairs Committee Chair Jonathan L. Myles, MD, FCAP presented the series on the 2015 Medicare Fee Schedule changes. To view a presentation and start viewing, select the topic by clicking a link below:

The videos play after entering your name and email address. CAP members are encouraged to share the link to this presentation with colleagues, administrators, and other interested stakeholders. In addition to viewing this on your computer, it can also be viewed on your smartphone or tablet by clicking the link to this presentation from your device.

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Use the CAP's "Role of Pathologists" infographic to help explain to policy influencers and other stakeholders how pathologists diagnose diseases and drive treatment decisions for patients.

The CAP's infographic is available for members to download. CAP members had used the infographic during the 2015 CAP Policy Meeting when meeting with their elected officials and legislative staffs on Hill Day May 6. The infographic is a helpful tool that can be used to explain what pathologists do, their role in diagnosing diseases, and how diagnoses are used to achieve better patient outcomes.

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