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Quarterly Advocacy Update

Keeping you informed on policy issues affecting pathology and laboratory medicine.

Recap of the Latest Advocacy News from July-September 2021

In this Issue:

Vast Majority of Pathologists to Avoid MIPS Penalties in 2020

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.

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CAP Urges Aetna to Reverse Reimbursement Limits, Clinical Pathology Services

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.

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Pathologists Quality Registry Earned 2020 CMS Approval To Optimize Medicare Payment

The CMS approved the Pathologists Quality Registry as a qualified clinical data registry for the fourth consecutive year. The CAP’s registry offers pathology practices a robust tool for complying with requirements under Medicare’s Quality Payment Program and Merit-Based Incentive Payment System (MIPS). Moreover, the CAP’s registry features quality measures and expert guidance, so pathologists get paid without further penalty by the Medicare program.

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Mississippi Pathologists, CAP Successfully Amend Second Autopsy Bill

The Mississippi Association of Pathologists (MAP) and the CAP on March 1 secured an amendment to a second autopsy bill that would establish a new position of “Medical Examiner Investigator.”

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Ohio Pathologists, CAP Seek Revision to Out-of-Network Reimbursement

The Ohio Society of Pathologists (OSP) and the CAP have asked the Ohio State Medical Association (OSMA) House to seek revisions to the payment for out-of-network services and adopt a specific policy requiring health plan network adequacy hospital-based physicians by specialty.

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Register Now for the 2021 Pathologists Leadership Summit

The 2021 Pathologists Leadership Summit, taking place virtually, May 1-4, is the meeting where CAP members will come together to set the path that moves our specialty forward.

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Relentless CAP Advocacy Wins MIPS Relief for Pathologists; No Medicare MIPS Penalties During Pandemic

The Centers for Medicare & Medicaid Services (CMS) will not enforce reporting penalties for 2020 reporting due to the COVID-19 public health emergency. The CMS will apply the Extreme and Uncontrollable Circumstances Hardship Exception policy to all MIPS eligible clinicians who do not submit any MIPS data for the 2020 performance period and avoid a 2022 payment penalty.

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Arizona Society of Pathologists, CAP Oppose Specimen Disposal Bill

The Arizona Society of Pathologists (ASP) and the CAP urged the state legislature to reject a bill requiring a clinical laboratory to dispose of any specimen within three days after a diagnostic test has been completed unless the laboratory has obtained specific patient consent.

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FDA Authorizes Johnson & Johnson Vaccine - NATHAN TEST

The FDA authorized the emergency use of a coronavirus vaccine from Johnson & Johnson, adding the third vaccine for the public.

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CAP Rallies Support for Additional $10 Billion to Expand Medical Supply Production

As the House works on its version of a legislative package to address the COVID-19 pandemic, the CAP urged Senate leaders to support testing services and laboratory frontline providers as they craft their own pandemic relief bill. The CAP is asking senators to increase resources for testing, enhance existing relief programs, and offer additional financial assistance to pathologists and laboratories.

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