During the 2024 American Medical Association (AMA) Interim Meeting from Nov. 8 to 12 in Orlando, Florida, the AMA House of Delegates addressed prior authorization requirements and the Medicare 14-Day Laboratory Date of Service Rule.
The AMA House of Delegates, which includes a delegation of the Pathology Section Council led by the College of American Pathologists (CAP), adopted a policy to stop payers from imposing burdensome prior authorization requirements, then reneging on their previously agreed-upon payment for the services provided. The policy is intended to “support the position that the practice of retrospective denial of payment or payment recoupment for care which has been precertified by an insurer should be prohibited under federal statute, except when materially false or fraudulent information has knowingly been given to the insurer by the physician, hospital, or ancillary service provider to obtain precertification.”
Delegates also directed the AMA to continue to advocate for legislation regulations that would require all health plans to pay for services that are preauthorized or precertified and to encourage legal action against health plans that engage in inappropriate postservice payment denials and payment recoupment.
Additionally, a resolution that received support from CAP petitions the AMA to advocate for changes to laboratory date of service rules under Medicare. Specifically, the Medicare 14-Day Laboratory Date of Service Rule would be revised to require complex laboratory services performed on pathologic specimens collected from an inpatient hospital procedure to be paid separately from inpatient bundled payments, consistent with outpatient rules. According to CAP, allowing a performing laboratory to bill directly for tests rather than receiving payment from the hospital would reduce administrative burdens and improve patients’ timely access to laboratory services.
Sources:
https://www.cap.org/advocacy/latest-news-and-practice-data/november-14-2024
