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CodeMap® 01/04/2013: Reimbursement and Compliance Developments CodeMap®-01/04/2013: Reimbursement and Compliance Developments Archive

CodeMap® Compliance Briefing: January 4, 2013


Editor's Welcome:

As most of you are aware, Congress has been busy over the New Year Holiday. This week, we will update our subscribers on how the recent, resulting legislation affects both the 2013 Medicare Laboratory Fee Schedule and the 2013 Medicare Physician Fee Schedule. In addition, this briefing reviews the latest OIG activity that affects providers of clinical laboratory and pathology services. Happy New Year.

Sincerely,

Gregory Root, Esq.


Reimbursement and Compliance Developments

by: Gregory Root, Esq.

gbroot@codemap.com

2013 Medicare Laboratory Fee Schedule

On New Year's Day, Congress passed the American Taxpayer Relief Act, which postponed all sequestration cuts until March 1, 2013. As such, at least for the next two months, the 2013 Medicare Laboratory Fee Schedule will be effective with an across the board 2.95% cut. What happens March 1, 2013, is entirely up to Congress, and at this point is anybody's guess. If we were forced to predict, we would guess that the sequestration cuts to Medicare will be eliminated and/or further postponed come March 1, 2013.

Other developments to the 2013 Medicare Laboratory Fee Schedule, which we previously discussed in earlier briefings, are as follows:

  • As expected, all new Molecular Pathology codes show $0.00 reimbursement pending assignment of pricing by individual Medicare contractors via the gap-filling process.
  • Multianalyte Assays with Algorithmic Analyses (MAAA) codes do not appear on the 2013 fee schedule since CMS has chosen to pay only for the component tests upon which the algorithm is based rather than recognize the new codes. Medicare providers should submit the component test codes individually for reimbursement, not the MAAA codes.

2013 Medicare Physician Fee Schedule

The recently enacted American Taxpayer Relief Act also prevented a 26.5% cut to the 2013 Medicare Physician Fee Schedule. The act postponed any cuts to the fee schedule due to the sustainable growth rate (SGR) until January 1, 2014. In other words, for most services, Medicare will continue to reimburse physicians at 2012 rates. However, please remember that the 2013 Medicare Physician Fee Schedule continues to include substantial cuts to the technical components of surgical pathology services unrelated to the SGR. The good news is that Congress prevented a 26.5% cut in the near term; the bad news is that Congress did nothing to reform the SGR and potentially even bigger cuts come next January. Also, as mentioned in the previous section, the act delays until March 1, 2013, an additional 2% cut due to sequestration.

CMS is currently revising the 2013 Medicare Physician Fee Schedule to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November.  Please remember that the Medicare Physician Fee Schedule includes reimbursement amounts that apply to our Laboratory/Pathology and Radiology publications.  We will send a publications shipping update once CMS publishes the revised fee schedule.

OIG Advisory Opinion Concerning Electronic Interfaces

On December 12, 2012, the OIG published Advisory Opinion No. 12-20 concerning electronic interfaces that are used by ordering physicians to order diagnostic tests and receive the results of such tests. Such interfaces are commonly used in the clinical laboratory industry. Specific language in the Stark regulations has long established that these interfaces will not be considered illegal remuneration under the Stark law as long as the interfaces are used solely to order tests and receive results. However, until recently, similar guidance has not existed concerning electronic interfaces and federal anti-kickback provisions.

The requestor of Advisory Opinion No. 12-20 proposed building an electronic interface that would allow referring physicians to order tests and retrieve results. The requestor of the opinion also planned to grant free access to the interface to all its referring customers. In this advisory opinion, the OIG states that the provision of items and services that are used only to order tests and communicate results are considered integral to the delivery of laboratory testing and should not represent illegal remuneration implicating the Anti-Kickback Law. The OIG states the following,

“Access to the Interface would be used by Physicians only to transmit orders for laboratory and diagnostic services to the Requestor and to receive the results of those services. Under the Proposed Arrangement, Interface access would be integrally related to the Requestor’s services, such that the free access would have no independent value to the Physicians apart from the services the Requestor provides. Accordingly, we conclude that the Proposed Arrangement would not, under these particular facts, implicate the anti-kickback statute.”

The recent opinion further demonstrates that clinical laboratories are in no danger of violating federal fraud and abuse provisions by delivering to their clients electronic interfaces that are used SOLELY to order tests and communicate results.

To access OIG Advisory Opinion No. 12-20 please click here.

OIG Compendium of Unimplemented Recommendations

Each year, the OIG publishes its Compendium of Unimplemented Recommendations. This publication reviews recommendations made by the OIG to CMS in recent years that, as the title indicates, remain unimplemented. The OIG released the 2012 edition last month and the report contains several recommendations concerning Medicare reimbursement for clinical laboratory services. The OIG states that it has on numerous occasions urged CMS to establish a beneficiary copay for lab services. The agency reminds CMS that laboratory services are one of the few benefits that are not accompanied by a copay to help control demand and utilization. The compendium also includes a recommendation for CMS to reevaluate the Medicare Laboratory Fee Schedule and how its payment amounts are determined. The OIG states that it suspects that the payment amounts established over 30 years ago are based on flawed data. The agency urges CMS to seek legislative solutions to establish a new payment system such as competitive bidding processes.

These unimplemented recommendations seem to be perennial favorites of the OIG and other agencies. Almost every year there is developing discussion concerning beneficiary copays and competitive bidding. 

To access the OIG's Compendium of Unimplemented Recommendations please click here.

That's all for this week. Please keep in mind that all our 2013 CodeMap® publications will contain the latest and most accurate coding, reimbursement, and coverage information. 


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02/13/2009: The Terminology of Coding
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CodeMap Compliance Briefing: 01/14/2009
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12/19/2008: Year End Radiology Wrap-Up
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CodeMap Compliance Briefing: 8/17/07: Medicare Claims Processing Rules
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04/13/2007: Coding Vocabulary
03/30/2007: Reimbursement Vocabulary
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3/2/07: The Physician Quality Reporting Initiative (PQRI)
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2/09/07: Glycosylated Hemoglobin (A1c) Test Codes
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CodeMap Compliance Briefing: 10/14/05: Providing Regulatory Information to Customers
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CodeMap Compliance Briefing 07/22/05: Coding Antibody and Antigen Assays II
07/08/2005 Coding Antibody and Antigen Assays: I
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05/20/05 Diagnosis Coding Rules Part 1
05/13/2005 Reflex Manual WBC Differentials
05/06/2005 Incident To Services
04/29/2005 CMS Manuals
04/22/2005 Reflex Testing
04/15/2005 Custom Panels
04/08/2005 Medicare Administrative Contractors (MACs)
04/01/2005 Place of Service (POS) Codes
03/18/2005 Subscriber Questions
03/11/2005 Medically Unbelieveable Edits
03/04/2005: Final Hospital Compliance Guidance 4
02/25/2005: Final Hospital Compliance Guidance 3
02/18/2005 Final Hospital Compliance Guidance 2
02/11/2005 Final Hospital Compliance Guidance
02/04/2005 Final Diabetes Screening Rules
01/28/2005 Medicare Appeals II
01/21/2005: Medicare Appeals I
01/14/2005 Providing Services to SNFs
01/07/2005 Medicare Errors
12/17/2004 Year End Subscriber Questions
12/10/2004 Coding Flow Cytometry Services
12/08/2004 Alert: 2005 CodeMap Manual Production Schedule
12/03/2004 Diabetes Screening Tests
11/22/2004 Announcing CodeMap Data Files
11/19/2004 Flow Cytometry Coding and Reimbursement
11/12/2004 New Venipuncture Rules
11/05/2004 Medicare Cardiovascular Screening Benefits
10/29/2004 Subscriber Questions
10/22/2004 Genetic Testing Modifiers
10/15/2004 Coding Glucose Tests
10/08/2004 Shared Laboratories
10/01/2004 Stark II and POLs
09/24/2004 New CPT Codes for Pathology Services
09/17/2004 New CPT Codes for Lab Services
08/27/2004 SNF Consolidated Billing Exceptions
08/20/2004 The OIG Exclusion Program
08/13/2004 Medicare Initial Preventive Physical Exam
08/06/2004 New Medicare Coverage for Screening Tests
07/30/2004 Discounts to Financially Needy Patients
07/23/2004 Date of Service for Lab Tests
07/16/2004 New CPT Codes for 2005
06/25/2004 Updates to NCDs and LMRPs
06/18/2004 New Compliance Program Guidance for Hospitals II
06/11/2004 New Compliance Program Guidance for Hospitals II
06/04/2004 Annual Physician Notices
05/21/2004 Screening Pap Smear Coverge
05/14/2004 Transfusion Medicine Codes II
05/07/2004 Transfusion Medicine Codes I
04/23/2004 Anti-Mark-Up Controversy
04/16/2004 Subscriber Questions
04/09/2004 Genetic Testing Codes II
04/02/2004 Genetic Testing Codes I
03/26/2004 Laboratory Marketing Practices III
03/19/2004 Laboratory Marketing Practices II
03/12/2004 Laboratory Marketing Practices I
03/05/2004 Medicare Payment for CLIA Waived Tests
02/27/2004 Medicare Payment for ReferredTests
02/20/2004 Grace Period for CPT Codes Eliminated
02/14/2004 CCI Edits Associated with New Lab and Pathology Codes
02/06/2004 CCI Edits Associated with New Radiology Codes
01/30/2004 Venipunctures
01/23/2004 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
01/16/2004 Travel Allowances
12/19/2003 Medicare Modernization Act
12/12/2003 Medicare Reform Bill Part 2
12/05/2003 Medicare Reform Bill Part 1
11/21/2003 New HCPCS Codes for CBCs without Platelets
11/07/2003 GA, GY and GZ Modifiers
10/31/2003 Specimen Collection
10/24/2003 Coding Qualitative Drugs-of-Abuse Tests
10/17/2003 The OIG's Work Plan, Medicare CDs, Recent Enforcement Actions.
10/10/2003 ESRD Composite Rate Lab Tests
10/03/2003 End Stage Renal Disease (ESRD) Reimbursement for Automated Tests
09/26/2003 Proposed Rules from the OIG
09/12/2003 Category III (Tracking) CPT Codes
09/05/2003 New Proposed Rules for Flow Cytometry
08/15/2003 Thyroid Testing
08/01/2003 CMS Lab Reimbursement Meeting
07/25/2003 NCD Misconceptions
07/18/2003 The -GZ Modifier
07/11/2003 Screening Mammogram Codes
06/27/2003 Correct Coding Edits II
06/20/2003 Correct Coding Edits I
06/13/2003 Diagnosis Coding Rules II
06/06/2003 Diagnosis Coding Rules I
05/23/2003 Revised Medicare Appeals Provisions II
05/16/2003 Revised Medicare Appeals Provisions I
05/09/2003 Business Associates Agreements
05/02/2003 Pathologist Interpretation of Clinical Lab Tests
04/25/2003 TC Billing of Pathology Services
04/18/2003 Medicare Reimbursement for Pathology Services
04/11/2003 How to Respond to a Search Warrant
03/28/2003 How to Respond to Subpoenas
03/21/2003 How to Respond to Investigators
03/14/2003 Mandatory Claim Submission
03/07/2003: Who Can Order Diagnostic Tests?
02/28/2003 Changes in 2003 Physician Fee Schedule
02/21/2003 Medical Necessity Requirements for Chemistry Panels, Part II
02/14/2003 Medical Necessity Requirements for Chemistry Panels I
02/07/2003: ABNs and Client Cooperation
01/31/2003: Patient Ordered and/or Performed Testing
01/24/2003: The Beneficiary Anti-Kickback Statute
01/17/2003: Significant Changes in 2003 Medicare Reimbursement
01/10/2003: 2003 Medicare Lab and Physician Fee Schedules
12/13/2002: More National Coverage Policies
12/06/2002: How Medicare Sets Fees for New CPT Codes
11/22/2002: Critical Year End Dates
11/15/2002: 2003 Medicare Laboratory Fee Schedule
11/08/2002: Stark Self-Referral Prohibitions
11/01/2002: Using Modifiers -59 and -91
10/25/2002: Introduction to Privacy Regulations
10/18/2002: New Codes for Obstetrical Ultrasound
10/11/2002: National Coverage Determinations (NCDs)
10/04/2002: Implementing a Radiology Compliance Program
09/27/2002: New 2003 Lab CPT Codes
09/20/2002: Automated Order Entry
09/13/2002: National Coverage Policy for Lipids
09/06/2002: The Anti-Kickback Statute
08/23/2002: Using the New ABN Forms
08/16/2002: Advance Beneficiary Notices
08/09/2002: Medicare Coverage for PET Scans
08/02/2002: Reflex Testing
07/26/2002: 2003 Hematology CPT Code Changes II
07/19/2002: 2003 Hematology CPT Code Changes I
07/12/2002: Direct Billing Rules II
06/28/2002: Direct Billing Rules I
06/21/2002: Medicare Reimbursement for Lipid Panels
06/14/2002: Bone Density Studies
06/07/2002: CLIA Waived Testing Rules
05/31/2002: Blood Draws and the Anti-kickback Statute
National Coverage Determination (NCD) Updates
05/01/2002 - CodeMap® Quarterly Reports, Volume I, No. 2
01/15/2002 - CodeMap® Quarterly Reports, Volume I, No. 1