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California Society of Pathologists
One Capitol Mall Suite 320
Sacramento, CA 95814 
Tel : 916-446-6001
Fax :  916-444-7462

Extension of Moratorium That Allows Independent Laboratories to Bill for the Technical Component (TC) of Physician Pathology Services Furnished to Hospital Patients

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, which extends the moratorium that allows independent laboratories to bill for the TC of physician pathology services furnished to patients in hospitals, effective for claims with dates of service on and after January 1, 2010, through December 31, 2010.

In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, CMS stated that it would implement a policy to pay only the hospital for the TC of physician pathology services furnished to hospital patients.  At the request of industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements, the implementation of this rule was administratively delayed.  Subsequent legislation formalized a moratorium on the implementation of the rule.

Although the previous extension of the moratorium expired at the end of 2009, Section 3104 of the Patient Protection and Affordable Care Act restored the moratorium retroactive to January 1, 2010.  Therefore, independent laboratories may now submit claims to Medicare for the TC of physician pathology services furnished to patients of a hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed.  This policy is effective for claims with dates of service on or after January 1, 2010, through December 31, 2010.  If an independent laboratory previously submitted a claim for services covered by this provision and the claim was denied, the laboratory may contact its Medicare contractor for further instructions.


Information Regarding the Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule (3-26-2010)

The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare Physician Fee Schedule (MPFS).  As you are aware, the Temporary Extension Act of 2010, enacted on March 2, 2010, extended the zero percent (0%) update to the 2010 MPFS through March 31, 2010.   


CMS believes Congress is working to avert the negative update that will take effect April 1.  Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April.  This hold will only affect claims with dates of service April 1, 2010, and forward.  In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. 

Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update. 



CSP is Pleased to Announce its Second in a Series of Webinars

Hospital Contracting- A Check-up for Pathology Groups

This session will provide you with insight and advice from two experienced healthcare attorneys on issues for pathologists in contracting with hospitals. It will provide knowledge as to fundamental issues to consider in contracting and a description of new and emerging issues to consider in structuring these relationships. A Q & A opportunity will also be included.

Thursday April 22, 2010 12:00 noon to 1:30
  • 60 minute presentation with 30 minutes for Q & A
  • Attendees will receive PDF document of the speaker outlines in advance
  • Hosted and Sponsored by the California Society of Pathologists
Pricing: Regular and Associate Members  $125
Non-Members  $150

Larry Kessenick, Esq., Partner Kessenick, Gamma and Free

Larry Kessenick has practiced law in San Francisco since January of 1970.   He has special expertise in all forms of health regulatory law as they affect the formation of physician business ventures, including Stark II, the federal anti-kickback law, and the Speier law. He is past president of the California Society of Healthcare Attorneys and served as a board member for many years.

Jerome Miller, Esq., Miller Health Law Group

Jeremy Miller is the founder and President of Miller Health Law Group in Los Angeles.  Jeremy is an honors graduate of the University of Illinois and of Northwestern University School of Law, where he served on the Law Review. For the past 29 years, Jeremy has specialized in the representation of providers in connection with their healthcare and related business law needs.

Online Registration will be available through our website tomorrow. You will be notified via email.