PATH News Network Daily Edition

Support Grows for Prior Authorization Reform in Congress

• College of American Pathologists

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SPEAKER_01

Growing support for prior authorization reform. How much of practice billings are uncompensated? And an upcoming webinar on how to lower that percentage. These stories and more coming up next. This is Path News Network Daily Edition from the College of American Pathologists. I'm Nick Lani. It's Tuesday, May 19th. A bill in Congress that would simplify the prior authorization process for Medicare Advantage plans is nearing an important threshold. The Improving Seniors Timely Access to Care Act is just a few co-sponsors shy from two-thirds support in the House of Representatives. That's the threshold for overriding a presidential veto, and it's considered a sign that the bill will likely become law. The CAP has supported the bill since it was introduced almost a year ago because pathology services often face reimbursement issues through Medicare Advantage plans. By streamlining the prior authorization process and making it more transparent, the bill would allow providers to spend more time on patient care and less on administrative red tape. Promising news for the use of immunotherapy to treat breast cancer. In a study published in Modern Pathology, researchers at the University of Groningen in the Netherlands reported that the presence of tertiary lymphoid structures, or TLSs, is linked with improved outcomes for breast cancer patients. TLSs are immune cells that accumulate in non-lymphoid tissues. Mature TLSs were detected in 5.6% of breast cancer patients in a survey of several hundred patients, and those patients had higher recurrence-free survival rates, confirming previous research showing that TLSs help immune cells infiltrate tumors. Because immunotherapy has had limited success in breast cancer treatment to date, identifying which patients are more likely to respond favorably could help clinicians choose a treatment option more quickly and effectively.org. And speaking of reimbursement, it's the topic of an upcoming CAP webinar. On June 16th at 1 p.m. Central, the CAP Practice Management Committee will host the Reimbursement Landscape in 2026 and beyond, featuring four experts in pathology and laboratory reimbursement across hospital, independent, and reference laboratory settings. They'll discuss emerging payer trends, focusing on the most common pressure points affecting pathology practices, with a special emphasis on changing technologies. Here's one of the panelists, Dr. Rebecca Obeng, assistant professor at Case Western University and University Hospitals Cleveland Medical Center.

SPEAKER_00

One of the things that the webinar wanted to highlight is now with the involvement of AI and potentially being used to sort of, you know, I guess automate the coding system with the billing process. And so I think a lot of pathologists may not necessarily think about it that way in terms of like, you know, what keywords that are should be mentioned in the report.

SPEAKER_01

You can register for the webinar at the CAP website. That's all for today. See the show notes for more information on today's stories. And if you've got a story we should be covering, email us at stories at CAP.org. We'll be back Wednesday at 5 a.m. Eastern for another episode of the Daily Edition. I'm Nick Lonnie. Have a wonderful day.