Time to Voice Concerns Over Medicare MoPath Reimbursement

Labs are actively petitioning both federal, state, and city representatives to voice their concerns over the drastic slash in reimbursement that has accompanied the new molecular pathology fee schedules released by Medicare Contractors. Councilmember Lorie Zapf of the City of San Diego has written CMS regarding her “concerns related to the process by which Medicare payment rates for certain genetic tests have been implemented” in hopes that “Medicare will consider reexamining the process by which genetic test pricing was recently issued by its carrier for this region, Palmetto GBA.” Councilmember Zapf has good reason to be concerned as San Diego is one of the largest healthcare and life-science hubs in the country and Zapf points out that the “genetic testing community stands out as a leading driver and economic multiplier” for the struggling state of California.

Zapf also points out that “genetic testing represents the type of personalized and preventative medicine that ultimately contributes to overall savings in healthcare spending.” Genetic and high complexity testing labs across the country have been facing economic peril over the past two months with many labs going through the process of laying off and/or removing critical genetic testing services from their menu. Since it is difficult to determine how medicare contractors came up with the rates released, labs have been pushing for a more transparent and collaborative pricing process that will continue to make high-cost but high-utility genetic tests available to medicare patients. Zapf indicates that she would like Medicare to examine the process utilized by Palmetto to confirm that it was “conducted in a manner that involved sufficient stakeholder input, and if not–that the pricing be repealed and Palmetto directed to reinitiate a process to meet CMS guidelines for transparency and due process.”

XiFin applauds Zapf for her clear and succinct letter that gets right to the heart of the Medicare MoPath payment rates issue, and encourages other labs to voice their concerns to contractors, CMS, and their representatives, as well.