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Following an initial launch of the laboratory benefit management program in Florida, UnitedHealthcare announced it will expand the program to include its members enrolled in commercial plans in Texas. The CAP opposed the pilot program in Florida and remains actively engaged with UnitedHealthcare regarding the program.

UnitedHealthcare announced in its October 2016 network bulletin (see page 19) that it would expand the program to Texas on March 1, 2017. The program is administered by Beacon Laboratory Benefit Solutions (BeaconLBS), a subsidiary of LabCorp.

In Florida, the pilot program affects over 80 laboratory services ordered by network providers in the state for patients insured by most UnitedHealthcare commercial plans. Ordering and rendering care providers use BeaconLBS Physician Decision Support tool to order tests for UnitedHealthcare patients covered by the program. The program also affects secondary review and claims payment to pathologists. Despite opposition from the CAP, Florida Society of Pathologists, the Florida Medical Association, the American Medical Association and several other physician organizations, UnitedHealthcare implemented the pilot program in April 2015.

The CAP will keep its members updated on this issue in future editions of STATLINE.

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Find out what Medicare will pay for pathology services in 2017 by registering and attending the CAP's webinar The Final 2017 Medicare Physician Fee Schedule's Impact on Pathology Services. The CAP will host this presentation for members on November 8 at 2 PM ET/1 PM CT.

Throughout this hour-long panel discussion, CAP experts will explain the changes by the Centers for Medicare & Medicaid Services (CMS) in the 2017 Medicare Physician Fee Schedule. Expected to be published by the CMS in late October, the fee schedule contains Medicare reimbursement and policy changes affecting pathologists.

Register today.

In July, the CMS provided detail on its intention to revalue certain pathology services targeted as potentially misvalued. For 2017, the CMS proposed increases for:

  • Pathology add-on services
  • Microslide consultations
  • Prostate biopsy, any method G-code
  • Tumor immunohistochemistry

The CMS also proposed decreases in the physician work and practice expense for some services, such as flow cytometry.

During the webinar presentation, CAP experts will discuss how the final rule affects Medicare reimbursement for pathology services and the CAP’s advocacy efforts to impact these changes. The second part of the webinar will be a question-and-answer session.

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As professional component (PC) billing remains a significant issue, the CAP continues to advocate for PC billing as a valid method of billing by pathologists for their clinical pathology services and to support members' PC billing advocacy efforts. To that end, the CAP updates to the PC Billing Information Package include coding guidance, legal precedent, and other information.

For many years, the CAP has made available to its members an informational package of guidance and resources regarding professional component billing. The Professional Component Billing Information Package  is available for members to download.

The information package offers legal and practical support for PC billing including coding guidance. The revisions focus on updates to coding, favorable legal precedent, and lessons learned based on recent experiences.

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