CAP, ACLA Support Removing Anatomic Pathology from In-Office Ancillary Services Exception
Congress has introduced a bill (HR 2914) that would eliminate advanced diagnostic imaging, anatomic pathology, radiation therapy, and physical therapy services from the Stark Law’s in-office ancillary services exception (IOASE). This follows three recent reports from the Government Accountability Office (GAO) expressing concern in the increase in utilization of certain ancillary services, such as anatomic pathology services, where providers self-refer. The GAO reported that the volume of self-referred anatomic pathology services more than doubled between 2004 and 2010. The GAO estimated that in 2010, self-referring providers made 910,000 more referrals than if their per-biopsy volumes were similar to non-referring providers. The bill has broad-based support from a number of health care industry trade associations and coalitions, including CAP and ACLA. CAP and ACLA would both prefer to have anatomic pathology services removed from the IOASE than to have CMS impose reimbursement cuts applicable to all laboratories providing pathology services as a way to curb abusive self-referral arrangements. Although HR 2914 has the support of many well-known organizations, its success is in the hands of Congress and President Obama. APS will continue to monitor this proposal and provide an update as soon as more information is available. If you have any additional questions, please contact your Account Manager.
In working through the wide variety of billing arrangements, APS found payments that we had been missing.