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AMA looks to expand colorectal cancer screening

To make colorectal screening more affordable and available, AMA delegates endorsed an advocacy effort at their annual meeting today that supports Medicare coverage for colorectal cancer screenings that are in line with Affordable Care Act-compliant plans.

The delegates also called on the AMA to work with colorectal screening specialists to create a guide to help ensure various screening scenarios are correctly billed, and to encourage understanding among health care providers, payers and patients so that all participants realize what will be covered at given cost-sharing levels.

“One in three people is not up to date on their colorectal screening, even though we know that, if colorectal cancer is caught early, the 5-year survival rate is 90%,” AMA board member Russ Kridel, MD, said in a press release. “The AMA needs to help patients understand the value of screening and help them gain access to it.”

The ACA mandated that private health insurance plans cover colorectal cancer screening without imposing any cost-sharing on patients. This component was clarified in federal government guidance that indicated insurance plans compliant with ACA cannot charge any patient cost sharing when a polyp is removed during a screening colonoscopy, according to the release.

However, Medicare coverage does not mirror commercial coverage. When an abnormal growth or polyp is removed during a colonoscopy, or when a biopsy is performed on suspicious-looking tissue, the “screening” colonoscopy becomes “diagnostic.” Though the Medicare Part B deductible is waived in these instances, beneficiaries are billed co-insurance of 20% of the procedure’s cost, the release stated.

“The differing coverage rules can lead to significant confusion, financial burden on patients and, finally, patients avoiding colorectal cancer screening,” the release stated. “Given the complicated coding and payment rules surrounding the screening, it is unsurprising that patients commonly find themselves billed for services they expected to be covered at no cost to them.”

The AMA action comes on the heels of the American Cancer Society’s recommendation to reduce the colorectal cancer screening age for average-risk individuals to 45 years. The U.S. Preventive Services Task Force recommends average-risk individuals undergo screening beginning at age 50 years. – by Janel Miller

Disclosure: Healio Family Medicine was unable to determine Kridel’s relevant financial disclosures prior to publication.