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October 30, 2018

In This Issue:

President Donald J. Trump signed the Support for Patients and Communities Act, which confronts the nation’s opioid epidemic, into law on October 24.

The law creates, expands, and reauthorizes programs and policies across several federal agencies aiming to address different aspects of the opioid epidemic, including prevention, treatment, and recovery. The final legislation, which passed with broad bipartisan support in the House and Senate, included a provision the CAP pursued that would allow autopsy report data to be collected by the Centers for Disease Control and Prevention (CDC) and used to track drug epidemics.

Recognizing that autopsy reports are an important source of information that can track drug-specific deaths, the bill language allots data from autopsy reports to be included in surveillance information to help address drug epidemics. Pathologists not only investigate drug overdose deaths but also certify the cause of death. The CAP also advocated for grant money to states/localities to help standardize data between medical examiner and coroner offices nationwide.

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The Centers for Medicare & Medicaid Services (CMS) detailed in new guidance for physicians and their practices how payment adjustments from the Merit-based Incentive Payment System (MIPS) will appear on a physician’s Remittance Advice for claims in 2019. 

The CMS published a FAQ document to help eligible clinicians, including pathologists, “understand how to identify and interpret the application of positive, neutral, and/or negative MIPS payment adjustments to be applied to payments.” The adjustments, which are based on 2017 MIPS performance, will be applied to all eligible clinicians’ services furnished 2019. 

Information about the adjustment will be printed on remittance advices following the adjudication of a Medicare claim for a service provided to a patient. In addition to other information on the remittance advice about payment, remittance advice codes will communicate what MIPS adjustments were made to the claim. For example:

  • Claim Adjustment Reason Code (CARC) 144 indicates a positive MIPS bonus or “Incentive adjustment, e.g. preferred product/service.”
  • CARC 237 indicates a negative MIPS adjustment or “Legislated/Regulatory Penalty.” 
  • Remittance Advice Remark Codes (RARCs) further explain an adjustment and RARC N807 means “Payment adjustment based on MIPS.”

The CMS has additional information about remittance advices available on its website.

Still have questions about your 2017 MIPS scores and 2018 MIPS reporting? The CAP has a number of MIPS resources to help members to learn more and navigate their Medicare payments, including information about 2018 reporting, a list of pathology applicable 2018 Improvement Activities, and an informational video. Email our experts with any additional questions about the Medicare incentive program at

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Soon the CMS will finalize the 2019 Medicare Physician Fee Schedule and Quality Payment Program changes that will impact Medicare pathology payment and services next year. The CAP is offering one of its most popular webinars - 2019 Final Medicare Policy and Payment Changes - where CAP experts will review the final regulation changes on November 9, 2018, at 11 AM ET.

Presenters are:

Donald Karcher, MD, FCAP

Donald S. Karcher, MD, FCAP
Chair of the Council on Government and Professional Affairs

Emily E. Volk, MD, FCAP

Emily E. Volk, MD, FCAP
Vice-Chair of the Council on Government and Professional Affairs
Chair of the CAP Clinical Data Registry Ad-Hoc Committee

W. Stephen Black-Schaffer MD, FCAP

W. Stephen Black-Schaffer MD, FCAP
Chair of the CAP Economic Affairs Committee

An accurate diagnosis is perhaps the single most important factor in effective patient care. No one knows this more than you. Connect with and educate legislators and policy experts on the value that pathology brings to the health care continuum.

Register and join us at the:

2019 Policy Meeting
April 29—May 1
Marriott Metro Center, Washington, DC

Make pathology’s impact on patient care heard in Washington.

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