UPDATES

June 29, 2012 

Palmetto Molecular Diagnostics Testing Program

You are aware of the program being implemented by our Medicare Carrier, Palmetto, on registration and reimbursement for some molecular diagnostic tests. There is continued dialogue with both CMS and Palmetto over the policy specifics and there is interest on our part in gathering data from California pathology groups with their experiences to-date with the new program.

There is interest regarding difficulties providers are having with registering for Z or PTI codes, meeting the data submission requirements knowing that there is a 6-month wait time to resubmit and favorable or unfavorable coverage determinations.  We note that there are very few coverage determination outcomes posted on Palmetto's website.  Any payment edits have just been implemented so experience to date may be very limited.  

If you have any experience that you would like to share please send your comments via email to bachermann@amgroup.us. This input will be valuable to us in our future policy development.

State Budget Contains Late Change to Medi-Cal Rates

There was a late addition to the budget discussions that occurred just prior to its adoption last week. It had not been proposed in either the Governor's proposed budget or his May Revise to the 2012-13 budget issued in early May. In further efforts to reduce state spending we saw the introduction of a new Medi-Cal change that would reduce clinical lab payments by 10% effective July 1, 2012.  As we have reported earlier the prior 10% Medi-Cal provider rate reduction, originally intended to be implemented on June 1, 2012 had been enjoined for many providers including physicians, but not for freestanding clinical labs. Clinical lab reimbursement was cut by 10% earlier this year.

This new change would reduce those rates by another 10% until a new lab reimbursement methodology is adopted by Medi-Cal. We have no idea what that "new" methodology is but will be part of the mandated stakeholder discussion process that was included in the budget trailer bill that included this provision and has been signed by the Governor. We believe this is driven by the settlements last year with several large clinical labs over allegations pursued by the Attorney General that these labs charged Medi-Cal more than they charged some private pay patients. Several of the settlement require the labs to charge Medi-Cal at lower rates for a fixed period of time. We assume that DHCS, in pursuit of budget savings, suggested this reduction since some labs were willing to provide services at these rates.   

We don't expect that DHCS can make this change by July 1 but there may be risk of retroactive application. We will monitor this issue and attempt to determine what this reduction applies to, e.g. anatomic vs clinical pathology. Once we have more information it will be provided to our members. The CSP did testify in opposition to this reduction in the Senate Budget Committee but to no avail.

Passing of Dr. Ronald Dorfman

It is with great sadness we are reporting the passing away of Dr. Ronald Dorfman on June 15, 2012  after sustaining a heart attack. 

Dr. Dorfman was well known in the pathology community for his valuable and long lasting contributions to the field of pathology, medicine and medical community are well known.  He will be greatly missed.

Condolences can be forwarded to his wife Zelma and his family at the following address:

Zelma Dorfman,
Channing House,
850 Webster Street, Apt. 923,
Palo Alto, CA 94301