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Medi-Cal to Change Clinical Lab Reimbursement
We reported in June on a late addition to the budget discussions that occurred just prior to its adoption in late June. 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. The CSP participated in a stakeholder meeting with DHCS on their proposed changes to clinical laboratory rates. This proposal was 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.
The CSP will be submitting some questions to DHCS on the process for fee schedule revision but here is what we know so far;
(1) We will be requesting a specific range of CPT codes that are impacted by this process. We assume this does not include anatomic pathology services.
(2) DHCS intends to require all clinical lab providers to submit the payment amounts they receive from a variety of payers. This data collection will apply to all lab providers including POLs and hospital outpatient labs.
(3) There was discussion of a possible template to make reporting easier. There was also a suggestion that single source tests or perhaps even highly specialized genetic tests not be reported the same way. Some of these specialty labs could report their average accepted rate since their volume is small.
(4) DHCS will have to request CMS approval for this different lab reimbursement methodology. DHCS will share the new rates with the stakeholders before they submit the request to CMS.
(5) Rate determination will exclude significant deviations of cost or volume factors and consider geographic areas.
(6) At this point DHCS expects that provider submissions will be due by December 27, 2012 and will be kept confidential.
This stakeholder process will continue and we will learn more about the specifics of how the data collection will be structured. We will attempt to minimize the burden on reporting and insure that the rate modifications provide reasonable reimbursement and allow patients access to a variety of clinical lab providers.
Important Notice From CAP on Meaningful Use for Pathologists August 24-CMS is granting pathologists short-term relief from penalties beginning in 2015 under the just-released final Stage 2 rules for the Meaningful Use EHR Incentive Program. In the CMS portion of the rule, the agency states that if a physician's specialty is defined as pathology, radiology or anesthesiology, the agency will not apply the penalties. In doing so, the agency is agreeing with CAP comments to the proposed rule (as well as from other provider groups) that these three specialties "lack face-to-face interactions and need to follow up with patients with sufficient frequency to warrant granting an exception to each EP [eligible provider] with one of these primary specialties." CMS goes on to state that physicians in these three specialties should not expect this exception to continue indefinitely, as it will be subject to an annual review. The College is supporting pending legislation to make this exception permanent. Introduced by Rep. Tom Price, MD (R-GA), The Health Information Technology Reform Act (H.R. 4066) exempts pathologists from eligibility for both Meaningful Use penalties and incentives. To date, CAP has secured 38 co-sponsors and continues to lobby for its enactment. CSP Reception During CAP '12 If you are attending the upcoming CAP meeting in San Diego please join other California pathologists for a reception on Monday September 10, 2012 at the Manchester Grand Hyatt in San Diego. California Society of Pathologists Reception Monday, September 10, 5:30 - 6:30 PM Gather with your California colleagues at the California Society of Pathologists reception. This is your opportunity to catch up with the CSP and other local pathologists. | 
