Medicare proposed changes

This was posted on the ACOR MM list. I hope we’ll all take some action!

For those of you who do not live in the US, I apologize. I also apologize for adding this to everyone’s email. I haven’t don’t this before so …

Apparently someone in the Center for Medicare Services (CMS) has come up with the following idea to save money. They will limit the number of times that certain laboratory tests will be reimbursed. CMS calls these tests Medically Unbelievable Edits (MUE’s).

Here are some examples of what will happen:
If a patient has a culture and sensitivity that determines what bacteria might be causing an infection and which antimicrobials will/will not work, then you can only have two per day. So don’t have bacteria in three places on the same day. One culture will have to wait for the next day

We all know of people who get more than one unit of blood per day in out-patient settings. Well, under this regulation, you will only be able to get 1 crossmatch per day which effectively limits you to one unit per day. And that will dramatically affect the treatment of anemia in out patients.

In the case of serum protein immunoelectrophoresis, CMS proposes to pay for only one assay per day. Specifically, you can get an IgG level but not an IgA or IgM on the same day.

In the case of flow cytometry, they will pay for 2 probes on any given day. Would you prefer CD5 and Cd 19 or CD20 and CD38 because you need to space them out over time? Where you usually can get a panel of molecular diagnostic markers performed at the same time, they will only pay for 1 a day. So, if your cells need to be tested with 10 markers, you need to have 1 performed per day.

In addition to detracting significantly from patient care, laboratory personnel will probably not refuse to perform these tests. But they won’t be able to bill Medicare for them. That means that they will either try to eat the cost (although that breaks a 19th century federal law on fraud and abuse) or charge the patient – except in those states that have no balance billing laws. Small laboratories such as Physician Office Laboratories or clinic laboratories or community hospital laboratories may go bankrupt and close or severely limit their service.

My suggestion is to call/email your Senators and Representatives to have them put pressure on CMS to withdraw this idea. You can also write directly to
Mark McClellan, M.D., Ph.D.
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-1502-FC
Room 445-G, HHH building
200 Independence Ave SW
Washington, DC 20201

The comment period ends on March 30 and unless turned back will go into effect on July 1, 2006.

Susan J. Leclair, Ph.D., CLS(NCA)
Chancellor Professor
Department of Medical Laboratory Science
University of Massachusetts Dartmouth
Dartmouth, Massachusetts 02747-2300

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