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What's New From IOP, LLC?
As Part of ObamaCares $716 Billion Cut to Medicare, CMS Announces Fee Cut to CPT Code 88305 for 2013
Effective January 1, 2013, CMS is reducing payment for CPT 88305. The net effect is a 33% reduction on global billing for your Medicare patient population. The College of American Pathology (CAP) and the American Clinical Laboratory Association (ACLA) are working to reverse this reduction. IOPs healthcare attorney has also informed us that this reduction is getting enormous attention from several parties. We will keep you apprised of any changes. We also have learned that this CMS decision was made before the RUC report was completed to provide actual data for such a change in reimbursement.
If you thought of opening a TC only lab this coming year forget about that move. The TC fee cut is 52% making a TC only lab probably not economical. That is why IOP has always stressed the implementation of global billing from the beginning. Those of you with TC only labs needing to upgrade to global billing should contact IOP today so we can help you cope with the new normal.
Depending on your practices Medicare patient population, the impact of your revenues will be substantially less. We have assembled a table which illustrates the estimated effect for different percentage levels of Medicare (2% up to 7%). For your copy please contact us either by phone (800.280.3785) or email at [email protected] to get your free copy.
CMS preliminary regulations issued in July had no change to CPT 88305. Their final regulations with the reduction in CPT 88305 were issued late last week. We reviewed the 1,235 page document. Fortunately, fees for special stains (CPT 88312 & 88313) and IHC stains (CPT 88342) were increased, as was the fee for CPT 88305 professional component (PC- 2% increase). The above mentioned chart includes those new fees.
We recommend the following strategies to cope with the fee reduction:
1. Labor is the largest expense in any business, hence payments to your pathologist should to be reduced to the "new normal" range of $10 to $15/biopsy. For 2013, CPT 88305 PC was increased by 2%. Remember, CAP and ACLA paid for the flawed Mitchell study on utilization. It is time for the "chickens to come home" to roost. Most of IOP contracted pathologists were paid $25 to $29/biopsy in the past. A $10 to $15 cut in pathologist fees will help make the laboratory finances look much better. It will in fact almost cut the payment reduction by 50%. Time to spread the wealth around for your benefit.
2. If your pathologist is unwilling to reduce his/her fee-for-service, IOP has arranged with a very large, multi specialty pathology group to provide non-Medicare diagnoses for $17/biopsy. They will also pay for shipping of slides and install a link to their computer system for results. We have known and worked with this pathology group over the past 2 decades. This applies only to states that are not direct bill states for Medicare. The CAP website (www.cap.org) has the most current listing of states.
3. Your Medicare patient technical work can also be sent to the above pathology group or you can send it to your local ACLA lab (Quest, LabCorp, Caris, GIP, local pathologist, etc.). Your pathologist can read the TC portion of the case (and probably lose money) and you can pay him/her at the "new normal" fees while you bill the pathology services (PC) from your in-office pathology lab.
4. If you would like IOP to re-do your proforma based on the new fees just let us know and we will be glad to do this for you.
5. IOP will also be happy to re-negotiate with your current pathologists for the "new normal" for PC fees for CPT code 88305 ($10 to $15 per biopsy).
If you have any questions, please IOP at 800.208.3785. This is the type of advice IOP routinely provides to our clients over the time of our agreements. We are your "partners" providing a security net for your practice pathology lab investment.
This is still an excellent investment for any GI, dermatology or multi-specialty group practice. Where else can you find an investment that has a return of six (6) months with a 40% profit margin in this stagnant economy?
http://www.iopathology.com/news.php
As Part of ObamaCares $716 Billion Cut to Medicare, CMS Announces Fee Cut to CPT Code 88305 for 2013
Effective January 1, 2013, CMS is reducing payment for CPT 88305. The net effect is a 33% reduction on global billing for your Medicare patient population. The College of American Pathology (CAP) and the American Clinical Laboratory Association (ACLA) are working to reverse this reduction. IOPs healthcare attorney has also informed us that this reduction is getting enormous attention from several parties. We will keep you apprised of any changes. We also have learned that this CMS decision was made before the RUC report was completed to provide actual data for such a change in reimbursement.
If you thought of opening a TC only lab this coming year forget about that move. The TC fee cut is 52% making a TC only lab probably not economical. That is why IOP has always stressed the implementation of global billing from the beginning. Those of you with TC only labs needing to upgrade to global billing should contact IOP today so we can help you cope with the new normal.
Depending on your practices Medicare patient population, the impact of your revenues will be substantially less. We have assembled a table which illustrates the estimated effect for different percentage levels of Medicare (2% up to 7%). For your copy please contact us either by phone (800.280.3785) or email at [email protected] to get your free copy.
CMS preliminary regulations issued in July had no change to CPT 88305. Their final regulations with the reduction in CPT 88305 were issued late last week. We reviewed the 1,235 page document. Fortunately, fees for special stains (CPT 88312 & 88313) and IHC stains (CPT 88342) were increased, as was the fee for CPT 88305 professional component (PC- 2% increase). The above mentioned chart includes those new fees.
We recommend the following strategies to cope with the fee reduction:
1. Labor is the largest expense in any business, hence payments to your pathologist should to be reduced to the "new normal" range of $10 to $15/biopsy. For 2013, CPT 88305 PC was increased by 2%. Remember, CAP and ACLA paid for the flawed Mitchell study on utilization. It is time for the "chickens to come home" to roost. Most of IOP contracted pathologists were paid $25 to $29/biopsy in the past. A $10 to $15 cut in pathologist fees will help make the laboratory finances look much better. It will in fact almost cut the payment reduction by 50%. Time to spread the wealth around for your benefit.
2. If your pathologist is unwilling to reduce his/her fee-for-service, IOP has arranged with a very large, multi specialty pathology group to provide non-Medicare diagnoses for $17/biopsy. They will also pay for shipping of slides and install a link to their computer system for results. We have known and worked with this pathology group over the past 2 decades. This applies only to states that are not direct bill states for Medicare. The CAP website (www.cap.org) has the most current listing of states.
3. Your Medicare patient technical work can also be sent to the above pathology group or you can send it to your local ACLA lab (Quest, LabCorp, Caris, GIP, local pathologist, etc.). Your pathologist can read the TC portion of the case (and probably lose money) and you can pay him/her at the "new normal" fees while you bill the pathology services (PC) from your in-office pathology lab.
4. If you would like IOP to re-do your proforma based on the new fees just let us know and we will be glad to do this for you.
5. IOP will also be happy to re-negotiate with your current pathologists for the "new normal" for PC fees for CPT code 88305 ($10 to $15 per biopsy).
If you have any questions, please IOP at 800.208.3785. This is the type of advice IOP routinely provides to our clients over the time of our agreements. We are your "partners" providing a security net for your practice pathology lab investment.
This is still an excellent investment for any GI, dermatology or multi-specialty group practice. Where else can you find an investment that has a return of six (6) months with a 40% profit margin in this stagnant economy?
http://www.iopathology.com/news.php
