On July 8, 2015, CMS issued a proposed rule that updates payment rates and quality provisions (PQRS) for services furnished under the Medicare Physician Fee Schedule on or after January 1, 2016. Part of those changes shows an increase to pathology of 1% in the RVU value for its services. That means for the professional component of 88305, the 2015 fee of $39.17 will increase to $39.72 in 2016. Another change which can affect pathology is that CMS is considering misvalued code changes for lower GI endoscopy services. Currently, anesthesia is separately reported and billed for many endoscopic procedures. CMS is indicating due to changes in practice patterns, they are considering establishing a uniform approach for all services that currently include moderate sedation in that rule. APS will continue to monitor this information as it’s released and updated and will report it in its newsletters.
The speed of APS’ technology coupled with the expertise of their staff resulted in accurate billing and complete claim resolution improving overall billing performance.