A loophole in current Medicare law may cause patients to think twice before undergoing colonoscopy for colorectal cancer screening.
Legislation introduced today seeks to ensure that colorectal cancer screening for all Medicare beneficiaries is free, as intended.
The Patient Protection and Affordable Care Act waives the coinsurance and deductible for many cancer screening testsi
, including colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT), which screen for colorectal cancer. Colonoscopy is a unique screening test because gastroenterologists are able to remove precancerous polyps and small cancers during the screening procedure. Under Medicare billing rules, removal of any polyp reclassifies the screening as a therapeutic procedure, for which patients will receive an unexpected coinsurance bill.
The Removing Barriers to Colorectal Cancer Screening Act of 2012 introduced today by Rep. Charlie Dent, R-PA, waives the coinsurance for a screening colonoscopy regardless of whether a polyp or lesion is found. Under current Medicare policy, the beneficiary deductible is waived regardless of whether a polyp or lesion is found. Congressman Dent's bill applies the same rational policy to beneficiary coinsurance.
The American Cancer Society Cancer Action Network (ACS CAN), the American Gastroenterological Association (AGA) and the American Society for Gastrointestinal Endoscopy (ASGE) have been advocating for the past year and half that Congress corrects this "cost-sharing" problem, which continues to cause confusion for patients and providers.
Cost sharing creates financial barriers, which could discourage the use of colonoscopy. The Removing Barriers to Colorectal Cancer Screening Act of 2012 is critical to achieving higher screening rates and reducing the incidence of colorectal cancer. Almost 38 percent of U.S. adults age 50 and older have never been screened, despite the fact that removing precancerous polyps cuts the death rate from colorectal cancer by half.
Christopher W. Hansen, president, ACS CAN
"I commend Representative Dent for this important effort to ensure that everyone has access to life saving cancer screenings, without regard to their ability pay. Too many Americans are going without lifesaving screenings because they cannot afford it. We urge Congress to help stop a cancer that can be prevented in many cases."
Lawrence S. Kim, MD, AGAF, Community Private Practice Councillor
"The rate of colorectal cancers and deaths can be decreased through the increased use of screening. However, a majority of Americans are still not participating in these lifesaving tests. The Removing Barriers to Colorectal Cancer Screening Act of 2012 will provide consistency and security for patients seeking colorectal cancer screenings by eliminating financial barriers and removing the confusion facing patients and their physicians over the current health-care policy. The bill introduced by Rep. Dent will help us to continue to increase the strides being made in colorectal cancer screening and, most importantly, save lives."
Gregory G. Ginsberg, MD, FASGE, president, American Society for Gastrointestinal Endoscopy
"Colorectal cancer is a largely preventable disease. The greatest benefit of colonoscopy screening is removing polyps that are discovered during screening and by so doing, significantly decreasing the risk for later cancer development. Converting a screening procedure that is fully covered by insurance with no cost-sharing, to one that does require cost-sharing by the patient after a polyp is found, is both a barrier to screening and inconsistent with the goal of the preventive services provision. We call upon Congress to pass this bill to fully eliminate the cost burden of colonoscopy colorectal cancer screening by waiving cost-sharing in the event that a polyp or cancer is removed."