Advocacy Update

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In an August 28 conference call with Anthem BlueCross BlueShield executives, key CAP leaders urged the insurer to reverse cuts to pathology services the insurer has rolled out in multiple states. The conference call is only the latest in a series of CAP communications with Anthem that began in April as the planned cuts unfolded over multiple states. CAP leaders argued that the cuts would undermine the viability of pathologists’ practices and undermine access to care for pathology services, particularly in rural communities.

The CAP leaders who participated in the call with Anthem were Donald Karcher, MD, FCAP; Emily E. Volk, MD, FCAP; Jonathan Myles, MD, FCAP; Stephen Black-Schaffer, MD, FCAP; and Jeff Welsh, MD, FCAP.

In response, Anthem claimed it had seen disparities in rates it was paying across settings, providers, and states—and has moved to rebalance its rates to provide a consistent out-of-pocket cost to its insured members. Anthem asserted that it did not just look at national laboratories but considered local market contracted rates in establishing its new fee schedules.

The CAP countered that this action could result in patient access issues, quality of care issues, and downstream costs for Anthem. CAP leaders also discussed with Anthem the complexity in valuing pathology services across different settings and argued that the insurer’s new rates would be unsustainable for practices and that pathology practices could close as a result of the Anthem payment reductions.

The Anthem executives were clear that the insurer does not plan to rescind or revisit its fee schedule changes but will continue to monitor the market response and further advised that pathologists with concerns should contact their regional network manager to discuss and share those concerns directly.

The CAP encourages pathologists impacted by Anthem’s payment reductions to review their contracts and to communicate any concerns directly with their respective Anthem regional network manager.

Following the CAP-Anthem conference call, CAP leaders met with the state presidents of pathology societies in states impacted by the Anthem fee schedule cuts to brief them on its call with Anthem. A number of state pathology societies, including the California Society of Pathologists and the Virginia Society of Pathologists, also have met with Anthem to urge the insurer to reconsider the cuts to pathology services.

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Are you being paid fairly for the pathology services you provide? Has surprise medical bills affected your reimbursements? Payment for pathology services has a direct impact on the success of your practice. These topics and more will be explored the following advocacy sessions at CAP19.

Advocacy Educational Sessions

  • Timely Topic – Surprise Billing (M1913N)
  • CPT Coding…You Can’t Practice Without It! Why Pathologists Need to Understand CPT Coding (M1962N)
  • Current Payment Policy Challenges in Pathology Practice (M1963N)
  • Thriving in MIPS and Other Value-Based Payment Programs (S1967S)
  • How is My Payment Determined for Pathology Services (MS1971S)
  • Advocacy Town Hall (M1911N)
  • Future of Pathologists in the Workforce (M1912N)

Still need to register for these courses. Check it out.

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The CAP hosted a webinar on August 29 with an in-depth overview of the proposed updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations.

If you were unable to attend the live event, a recording link and PDF presentation are available to view and download.

Watch the webinar and download the slides.

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Try your advocacy luck and take the new September Advocacy News Quiz.

Last month, over 200 of your fellow CAP members tested their advocacy knowledge. See how you measure up against your fellow pathologists on this month’s quiz and share your results. Good luck!

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