ACLA Praises Senate Letter to Tavenner Urging Open Process and Stakeholder Input in Review of Misvalued Codes In Medicare Part B Program

Washington, D.C. – The American Clinical Laboratory Association (ACLA) today praised a dozen U.S. Senators for their letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner, that urges CMS to open the current process and “allow adequate time for stakeholder engagement, feedback and preparation before any changes are finalized” in the review process to determine whether there are misvalued codes in Medicare Part B program. CMS’s authority was expanded under the Affordable Care Act (ACA) to periodically review physician services in the Medicare Part B program in order to identify any misvalued codes and take steps to revise payment for the codes.

“As providers of millions of clinical diagnostic laboratory services for Medicare beneficiaries each year, ACLA members are concerned that the current process for identifying misvalued codes in Medicare Part B does not allow enough time for feedback or stakeholder input,” said Alan Mertz, President of the ACLA. “We respectfully request that CMS revise their procedures regarding misvalued codes and provide the time necessary for meaningful and thoughtful comment, which the current timeline does not allow.”

The letter to Tavenner sent on June 13, 2014 is signed by Senators Kay Hagen (D-NC), Kelly Ayotee (R-NH), Richard Burr (R-NC), Johnny Isakson (R-GA), John McCain (R-AZ), Roy Blunt (R-MO), Deb Fischer (R-NE), Rob Portman (R-OH), Saxby Chambliss (R-GA), Dan Coats (R-IN), John Thune (R-SC) and Mark Kirk (R-IL).

The Senators point out in the letter that, “Historically, CMS has sought the input of outside stakeholders as guidance to assist with the valuations process.  Additionally, the Agency undergoes a separate and independent analysis for determining the relative value units (RVUs) for each service.  However, when the results of CMS’ analysis and the rationale for any payment modifications are only included in the final rule, as opposed to the annual proposed rule, the process limits the ability of providers to review the rationale and various methodologies used in revising the payment codes.  It also makes it more difficult for providers to prepare for any changes to payment, including how any revisions might impact their practices and patients.”

The senators note they support the accurate valuation of reimbursement rates for services provided under the Medicare program but call on CMS to allow both patients and provider the opportunity to comment on how policy changes may impact access to healthcare services.

In conclusion, they ask Administrator Tavenner to “strongly consider revising the current process by publishing these reimbursement changes to existing codes in the annual physician fee schedule proposed rule.”



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