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Close Medicare's Colonoscopy Loophole

ASCA urges facilities to contact lawmakers, support co-pay fix.

Published: January 16, 2014

The ASC Association is hoping that the unified voices of the outpatient surgery industry will spur Congress to act for the benefit of Medicare's colonoscopy patients.

The organization is urging ASCs nationwide to petition their U.S. representatives to support a change in the way Medicare collects colonoscopy co-pays.

2010's Affordable Care Act waived all co-insurance payments for colorectal cancer screenings. If, however, a colonoscopy reveals a polyp and the endoscopist removes it, the diagnostic screening is reclassified as a therapeutic procedure in the eyes of insurers.

While a commercially insured patient won't be charged a co-pay for a screening-turned-surgery, Medicare patients are still on the hook due to an inadvertent loophole in the healthcare reform law.

A potential fix, House Bill 1070, the Removing Barriers to Colorectal Cancer Act, was introduced on March 12 of last year, but has been languishing before the Ways and Means Committee and the Energy and Commerce Committee since that day. A previous attempt to close the loophole expired at the end of Congress's 2012-2013 session.

ASCA lobbyists are pinning the bill's hopes on a letter that is currently circulating in the House. Signed by representatives from both parties, it demands that the committees' leaders include the co-pay fix proposal in any upcoming Medicare reform legislation.

David Bernard

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