Aetna to Require Accreditation for In-Office Pathology Labs
Effective August 1, 2012, Aetna will require physician practices with in-office pathology labs to be accredited either by CAP or the Joint Commission (JCAHO), in addition to being CLIA-certified, in order to obtain reimbursement for surgical pathology services. Aetna, the third-largest health insurance carrier in the United States, advised that in-office labs that do not meet this requirement by August 1st will need to refer Aetna patients to other labs, such as Quest or AmeriPath, that are part of Aetna’s network. This new requirement applies to the technical and professional component for CPT codes 88300-88314 and 88342.
There are currently more than 3,000 CLIA-certified in-office pathology labs throughout the United States, most of which are inspected by CMS or state health departments. The CAP and JCAHO accreditations require more time and are more expensive. CAP states that an initial inspection usually takes anywhere from six to nine months after the receipt of application, and it can take another two or three months after the successfully-passed inspection to receive accreditation. Since Aetna’s announcement, CAP states that it has seen an increase of accreditation requests which may further delay the accreditation process for physician practices. CAP says that the current application fee is $799 and that its accreditation can cost the typical in-office lab approximately $1,500 annually.
In working through the wide variety of billing arrangements, APS found payments that we had been missing.