News from the AGA

AGA urges Medicare to fix CRC screening coinsurance issue


AGA and our sister societies met with Medicare staff in Washington, DC, to voice our opposition to its proposal 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, because of 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.

The gastroenterology community, together with patient advocates, has been asking CMS since 2011 to use its authority to fix the Medicare screening colonoscopy coinsurance problem. It was never the intention of Congress for polypectomy resulting from the initial screening to be excluded from the screening benefit. The Obama administration provided guidance for commercial plans on this screening benefit and stated that plans should not impose coinsurance since “removal of polyp is integral to the screening” and thus most private insurers recognize the benefit of waiving the coinsurance.

In our meeting with Medicare, we told them that beneficiaries should 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 needs to hear from you today. Sign our letter on to let your voice be heard.

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