Senators urge CMS to enable stakeholder input in review of misvalued codes in Medicare Part B program

June 25, 2014

A dozen United States senators recently wrote a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner, urging that CMS “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 the 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.

The senators point out in the publicly released 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 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.” In conclusion, the legislators ask Tavenner to “strongly consider revising the current process by publishing these reimbursement changes to existing codes in the annual physician fee schedule proposed rule.”

The American Clinical Laboratory Association (ACLA) is one organization that has praised the senators’ stance. “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,” says Alan Mertz, ACLA president. Read the letter in full.

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