CMS Reimbursement Rates

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Well, November 1st is day after tomorrow. Guess we'll know then, right? Watched the head of CMS during her congressional drilling on Obamacare. She was arrogant and basically flipped off all of congress saying they'd know something by November 15th. Do you think if this woman doesn't gives a rat's a** about what congress thinks that she will be overly concerned with private labs and CAP. Please, get real.
 












Anonymous said:
Decision has been delayed. Have you been under rock or something? We'll find out later next month. It's game over for independent labs VERY soon.
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Doesn't mean he was under a rock. It looks like this decision was made 10 days ago, and it takes a while for things to filter down. Also, a cautious person doesn't take hearsay as hard truth without some confirmation. Here is a link from CMS that says the final decision will come 'on or before November 27'. CMS seems to be attributing the delay to the government shutdown, not for thoughtful reconsideration. Congressional support is still way too insignificant with 38 senators, and I think, 115 or so representatives. I agree with the poster that this issue's thunder has been stolen by the disatrous rollout of Obamacare.

http://pathologyblawg.com/pathology...-cms-reconsider-pathology-reimbursement-cuts/
 






Congressional support is too weak to change the pending cuts or or approve the pending cuts? I can't get a sense of wether these changes are actually going to take place or not! Thanks for any input.
 






Anonymous said:
Congressional support is too weak to change the pending cuts or or approve the pending cuts? I can't get a sense of wether these changes are actually going to take place or not! Thanks for any input.
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Seems like no one actually knows. However, if you have fewer than a half of all senators even making suggestions (and that is all it is, no laws here) to CMS and only about a fourth of representatives, what is the chance that CMS will listen? Sounds like CMS has gone rogue like the IRS and does as it pleases. Right now, what pleases is cuts. Medicare recipients are going to get hit harder and harder as premiums go up and benefits go down. This is just one little part of it. This is the new normal.
 






Anonymous said:
Seems like no one actually knows. However, if you have fewer than a half of all senators even making suggestions (and that is all it is, no laws here) to CMS and only about a fourth of representatives, what is the chance that CMS will listen? Sounds like CMS has gone rogue like the IRS and does as it pleases. Right now, what pleases is cuts. Medicare recipients are going to get hit harder and harder as premiums go up and benefits go down. This is just one little part of it. This is the new normal.
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The waiting and wondering is hard.
 


















Anonymous said:
No one can know for sure, but from a reliable source, I hear the odds are at least 8 out ten that the cuts as proposed will go through.
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CAP is vigorously fighting the laboratory cuts in the medicare physician fee schedule for 2014.

According to the most recent CAP STATLINE report, CAP has admitted the proposed cuts to in-situ hybridization and immunohistochemistry are inevitable.

IMO Abbott, Quest, or LabCorp buys this company or it's lights out.

Just to emphasize the impact of these cuts, see below:

CPT code Description 2013 payment 2014 payment

88367 TC A Insitu hybridization auto $198.35 $40.30 (-80%)

88365 TC A Insitu hybridization (fish) $120.44 $40.30 (-67%)

88342 TC A Immunohistochemistry $73.15 $40.30 (-45%)


CMS to Finalize Proposed Physician Fee Schedule Rule by Nov. 27; CAP Expects Cuts to Some Key Pathology Codes; Other Key Payment Decisions

CAP expects the final 2014 rule to include cuts to the following pathology code families.

Immunohistochemistry – 88342 (PC & TC)
Enhanced Cytology Services – 88112 (PC & TC)
In situ Hybridization – 88365, 88367, and 88368 (PC & TC)

CMS also requested additional information on the payment level for 88305 TC. CMS reduced payment for 88305 TC by 52 percent last year. The College has provided additional information to CMS on the valuation of the technical component and has argued that the TC was reduced too steeply in 2013 and did not include some key input costs.

CMS has expanded its “misvalued code” initiative by targeting the top expenditure codes from each specialty as potentially overvalued, which triggered the review of the three additional code families.

As regular readers of this newsletter know, CAP has strongly opposed the CMS proposal to link payment for 39 pathology services to the Hospital Outpatient Rates and the additional proposal to “bundle” pathology and laboratory services into the Hospital Outpatient Payment Rates. Since July 8, 2013, CAP has vigorously advocated for the withdrawal of these policy proposals through multiple channels, including comment letters to CMS and member visits to Capitol Hill and the White House.

At the same time, the CAP has also been working through the AMA Relative Value Update Committee to mitigate the payment reductions to specific pathology services by ensuring that the revaluations of pathology services accurately account for the cost of delivering the service. Nevertheless, some reductions are inevitable, particularly to some services, which may not have been revalued for many years.

As the clock ticks down, and as we wait for publication of the proposed rule, CAP’s policy team will continue to keep members updated on any new developments.
 












maybe they go antitrust eventually, 2 labs to choose from for FISH? Luckily where I am currently we do not have to pay for probes so do not mind the cuts as it eliminates competition........well I do mind the cuts on the basis of the under value of diagnosis/prognosis and labs are such a small % of the bill.
 






























Have not heard anything - nothing on CAP website, pathologyblawg or anywhere else. Isn't it going to be great when our country moves to a single payer system and the government is in control of everything related to health care??? I can't wait.
 






























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