Here is the full text of the CAP memo about the reimbursement cuts:
Changes Anticipated in Surgical Path Reimbursement in 2013
Reimbursement for certain high volume anatomic pathology codes will likely be reduced beginning in January 2013, as part of CMS efforts to advance initiatives embedded in the health care reform law that scrutinize high volume codes as potentially overvalued while boosting support for primary care services.
Medicare first announced its intention to review the codes as potentially overvalued last year in the 2012 proposed physician fee schedule, and finalized this request for the technical component (TC) of 88305 to undergo review last November in the agencys final 2012 physician fee schedule regulation. The expected reimbursement changes to the TC of the surgical pathology code family (88300-88309) will be announced in November when CMS releases the Final Physician Fee Schedule for calendar year 2013.
The Health Care Reform law empowered CMS to review and revalue high volume codes from all specialties as potentially overvalued services, said Jonathan L. Myles, MD, FCAP, Chair of CAPs Economic Affairs Committee (EAC). In 2010, the CAP was able to maintain the value for the PC of 88305 and other surgical pathology codes.
Last year, CMS flagged the PC and TC of 88305 for review. After the College successfully argued that the 88305 PC had been reviewed as recently as April 2010, CMS limited their request for review to the TC. However, as the TC was originally valued in 2000, scrutiny of the costs associated with this code has been steadily increasing. The College continues to advocate for appropriate value through the AMA/Specialty Society Relative Value Scale Update Committee [RUC] review process, stated Dr. Myles, who is the CAP Advisor the RUC.
Be Prepared for Medicare Reimbursement Changes
As these codes are most likely to be revalued, pathologists need to start preparing, advised Mark Synovec, MD, FCAP, a member of the CAP EAC team. Its very likely that CMS will decrease the reimbursement of these high volume codes, explained Dr. Synovec, who practices with the independent group Topeka Pathology Group PA in Kansas. All pathologists need to be aware that this is likely to happen and assess the impact on their practices.
The extent of the impact will depend on the nature of each practices contracts and billing arrangements. This is very complex and requires planning and scrutiny of ones own practice, said Dr. Synovec, The impact will depend on the percentage of cases that you are billing the technical component of these services to Medicare, as well as the distribution of the codes used, as the revaluation will likely effect different codes to varying degrees. Knowledge of the code distribution for a practice would aid in planning for anticipated changes.
Changes in the Medicare TC valuation may affect other billing arrangements such as if your practice dealt with the end of the TC-grandfather exemption by forming a hospital contract linking TC-payments to a percentage of the Medicare rate. For all of these reasons, even though we donât know the details until CMS releases the final Physician Fee Schedule in November, if you bill TC at all, these changes will impact you, explained Dr. Synovec.
Start preparing plan B guys and gals.