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ADVOCACY

Aetna Reaffirms In-Office Pathology Lab Accreditation Payment Policy

Last March, Aetna notified all specialists performing in-office surgical pathology lab services that, in order to receive payment for services, practices offering in-office surgical pathology testing will be required to have their lab certified with Clinical Laboratory Improvement Amendments (CLIA) and one of the following accrediting entities under CLIA: 

This fall, the AMA along with 22 other medical societies, including ASGE, sent a letter to Aetna, expressing concerns that there are no quality issues within in-office pathology labs that would warrant this change in policy.  This new requirement by Aetna joins a number of other fiscal challenges facing physicians in this evolving payment and delivery system. For small labs, the financial impact of accreditation could be considerable, generally much higher than CLIA, depending on the lab’s volume and complexity of tests, these costs could range from $1,200-$2000 per year. 

Glenn Littenberg, MD, ASGE Practice Management Chair believes that in-office pathology labs are already required to meet high quality standards set forth by the CLIA and this new policy should not apply to GI.  Virtually all GI groups that have incorporated pathology services into their group either employ a GI-trained pathologist to read their slides or, at a minimum, have a GI-trained pathologist oversee the quality and functions of their labs.

Upon review of the concerns expressed, Aetna upheld its decision and extended the deadline to April 1, 2013 for in-office pathology labs to meet this requirement.

A three-month extension may not be enough time for in-office pathology labs to meet this requirement.  According to the CAP webpage on accreditation, “It can generally take 6-9 months from receipt of completed application to the initial inspection.  It then takes another 2-3 months for accreditation to be issued if the laboratory meets all qualifications and resolve deficiencies.”   

It is highly unlikely that practices starting the accreditation process today will meet the deadline, as approval process times are expected to increase due to the high volume of applicants.

ASGE will continue to speak against the inappropriateness of this requirement for GI and the undue fiscal burden it causes practices.  Proof of accreditation from one of the accrediting entities under CLIA can be sent to Aetna by emailing NationalAncillaryContracting@aetna.com.  

 

November 2012