{"id":4438,"date":"2012-06-01T23:51:00","date_gmt":"2012-06-01T23:51:00","guid":{"rendered":"https:\/\/www.healthlawpolicymatters.com\/?p=4438"},"modified":"2021-11-02T23:52:57","modified_gmt":"2021-11-02T23:52:57","slug":"expiration-of-grandfather-protection-for-technical-component-services-billing-is-looming","status":"publish","type":"post","link":"https:\/\/www.healthlawpolicymatters.com\/2012\/06\/01\/expiration-of-grandfather-protection-for-technical-component-services-billing-is-looming\/","title":{"rendered":"Expiration of Grandfather Protection for Technical Component Services Billing Is Looming"},"content":{"rendered":"\n<p>One month from today, the\u00a0<a href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/BILLS-112hr3630ih\/pdf\/BILLS-112hr3630ih.pdf\">law<\/a>\u00a0that permits independent laboratories to\u00a0bill and receive payment from Medicare Part B for the technical component of certain anatomic pathology, cytopathology, and surgical pathology services (\u201cTC Services\u201d) provided to patients of \u201ccovered hospitals\u201d will expire.<\/p>\n\n\n\n<p>Medicare pays hospitals a per-discharge amount for inpatient services pursuant to the inpatient prospective payment system.&nbsp; Similarly, outpatient services are reimbursed on a per-procedure basis under the outpatient prospective payment system.&nbsp; For both inpatients and outpatients, the payment received includes most services provided&nbsp;to the patient.<\/p>\n\n\n\n<p>Payments for inpatient services include all clinical laboratory services as well as&nbsp;TC Services.&nbsp; Clinical laboratory services and TC Services provided to outpatients are separately billable, but the hospital, rather than the independent laboratory, must submit claims for those services&nbsp;to&nbsp;Medicare.<\/p>\n\n\n\n<p>In 2000, Congress enacted the Grandfather Clause to prevent the\u00a0<a href=\"http:\/\/www.cms.gov\/\">Centers for Medicare &amp; Medicaid Services<\/a>\u00a0from ceasing to pay independent laboratories separately for TC Services furnished to patients of hospitals who had an agreement with an independent laboratory for the provision of those services as of July 22, 1999 (referred to as \u201ccovered hospitals\u201d in the statute).\u00a0\u00a0The original legislation applied to services furnished to a covered hospital through 2002, but Congress has since extended the provision many times.\u00a0 The current extension runs through\u00a0July 1, 2012, but Congress is not\u00a0expected to grant additional extensions due to concerns about Medicare paying twice for the same services and about CMS\u2019s ability to determine with certainty which hospitals qualify as \u201ccovered hospitals.\u201d\u00a0\u00a0 In addition, eliminating the protection would reportedly save $50 million per year.<\/p>\n\n\n\n<p>Although the American Clinical Laboratory Association, the\u00a0<a href=\"http:\/\/www.cap.org\/\">College of American Pathologists<\/a>, and others continue their lobbying efforts, chances for an additional\u00a0extension appear bleak.\u00a0 Covered hospitals and the independent laboratories with which they do business should therefore begin to prepare for this substantial change in their business relationship.\u00a0\u00a0Independent laboratories will have no choice but to look to those hospitals previously covered by the Grandfather Clause for payment for TC Services provided to their patients because the laboratories can no longer bill Medicare.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>One month from today, the\u00a0law\u00a0that permits independent laboratories to\u00a0bill and receive payment from Medicare Part B for the technical component of certain anatomic pathology, cytopathology, and surgical pathology services (\u201cTC Services\u201d) provided to patients of \u201ccovered hospitals\u201d will expire. Medicare pays hospitals a per-discharge amount for inpatient services pursuant to the inpatient prospective payment system.&nbsp; &#8230; <a title=\"Expiration of Grandfather Protection for Technical Component Services Billing Is Looming\" class=\"read-more\" href=\"https:\/\/www.healthlawpolicymatters.com\/2012\/06\/01\/expiration-of-grandfather-protection-for-technical-component-services-billing-is-looming\/\" aria-label=\"More on Expiration of Grandfather Protection for Technical Component Services Billing Is Looming\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_generate-full-width-content":""},"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/posts\/4438"}],"collection":[{"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/comments?post=4438"}],"version-history":[{"count":2,"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/posts\/4438\/revisions"}],"predecessor-version":[{"id":4440,"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/posts\/4438\/revisions\/4440"}],"wp:attachment":[{"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/media?parent=4438"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/categories?post=4438"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.healthlawpolicymatters.com\/wp-json\/wp\/v2\/tags?post=4438"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}