In late July, Medicare published a proposal in the 2020 Medicare Physician Fee Schedule (MPFS) proposed rule that would require physicians to inform patients about potential colorectal cancer (CRC) screening costs. Under the proposal, physicians who plan to perform a CRC screening for a Medicare beneficiary must tell the beneficiary in advance that they may have to pay coinsurance under the Medicare program if the screening finds polyps that are removed as part of the screening procedure and document the conversation in the beneficiary’s medical record starting Jan. 1, 2020.
Under the Affordable Care Act, Medicare beneficiaries do not need to pay for screenings that receive an A or B from the U.S. Preventive Services Task Force (USPSTF), such as screening colonoscopy. However, due to Medicare’s interpretation of the coding rules, when a polyp is found and removed during a screening colonoscopy, it is considered a diagnostic procedure and the patient is required to pay the coinsurance. Medicare’s new proposal does not solve the underlying problem — fixing the coinsurance issue for Medicare beneficiaries; instead, it shifts responsibility to notify Medicare beneficiaries to the physician.
When AGA and our sister societies met with Medicare in August, we told them that beneficiaries should be not be penalized because of the agency’s misinterpretation of Congress’ legislation. We also urged Medicare not to add to physician burden, to take responsibility for notifying patients of its own coverage and payment policies, and to focus on ways to help patients avoid unfair financial penalties resulting from its misinterpretation of Congress’s mandate for free CRC screening. Medicare will take all public comments into consideration and will release any new rules concerning CRC screening beneficiary education to Medicare coinsurance rules in the 2020 MPFS final rule expected in late October/early November.