COVID-19 Resources and News

2022 Proposed MPFS: See impact to pathology, labs

Pathologists and independent laboratories will experience a handful of significant payment reductions for key services if CMS adopts changes released Tuesday in the 2022 Medicare Physician Fee Schedule (MPFS) Proposed Rule.

Covid Billing

UHC eliminates some OON non-emergency coverage

As part of a new policy update, UnitedHealthcare will no longer cover non-emergency services members receive from out-of-network facilities outside their service area, effective July 1.

HRSA Uninsured Portal gets $4.8 billion boost for Covid-19 testing

On Wednesday, The U.S. Department of Health and Human Services (HHS) announced the agency is directing another $4.8 billion to fund Covid-19 testing for uninsured patients through the Health Resources and Services Administration (HRSA) Uninsured Portal.

CMS eliminating Cost category for 2020 MIPS scoring

Yesterday, CMS announced the agency is not scoring the Cost category for 2020 Merit-based Incentive Payment System (MIPS) participants due to reporting volumes being so heavily affected by the Covid-19 Public Health Emergency and other factors.

HHS offering vaccine reimbursement portal for underinsured patients

Providers who have previously been left footing the bill after administering Covid-19 vaccines to patients whose insurance doesn't cover the shot can now turn to a new reimbursement option being offered by The Department of Health and Human Services (HHS).

Video: What does the end of Covid-19 look like?

In his latest video, Vachette President Mick Raich looks ahead to what could lead to an end of the current environment of widespread payer coverage for Covid-19 testing and treatment.

Covid vaccine billing FAQ

As the U.S. continues to ramp up its efforts to administer Covid-19 vaccines, many providers have been inquiring about the process for becoming eligible to compliantly bill for vaccines.

With that in mind, the Vachette team has put together a helpful FAQ that covers Medicare payments, how to become a Mass Immunizer, compliant roster billing and more. The full document (PDF) may be downloaded below.

UHC placing ‘pre-pay’ review on some Covid claims

Multiple labs Vachette works with have recently received records requests from UnitedHealthcare to support their Covid-19 testing. While UHC isn't denying these tests for improper coding, the payments they've put on hold amount to nearly $1 million in some instances.

CMS boosts Medicare payment for Covid-19 vaccine administration

CMS announced the Medicare payment for administering Covid-19 vaccines has been increased in an effort by the Biden Administration to expand capacity and vaccinate as many adults as quickly as possible, according to a press issued by CMS today.

CEO update: Examining UHC’s Designated Diagnostic Provider Program and more

In this week's update, Vachette and Stark Medical Auditing CEO Mick Raich reviews UHC’s new Designated Diagnostic Provider Program that will restrict outpatient lab payments for labs who don’t gain entry. He also examines a number of recent audit findings and provides an update of the latest Covid billing issues.

HHS extends Provider Relief Fund reporting deadline, now asking recipients to register

After initially asking providers who received a distribution from the Health and Human Services Provider Relief Fund (PRF) to report on the use of those funds by Feb. 15, HHS is now allowing recipients more time to report due to the ongoing Public Health Emergency (PHE) and changes brought about by the latest COVID relief package.

Image by Jan Vašek from Pixabay

Free Webinar: Strategies for maximizing Covid opportunities in 2021

With the Covid-19 Public Health Emergency now set to stretch into at least mid-April 2021, labs and pathologists working to meet the testing demand must continue to refine their strategies as it becomes increasingly clear this will be a significant line of business throughout 2021.

Covid Billing

2021 Medicare Fee Schedule boost: See impact to pathology services

As part of the COVID relief and and appropriations package signed into effect Dec. 27, Congress took steps to mitigate significant fee schedule reductions for several specialties that were designed to offset payment boosts for evaluation and management (E/M) services.

Pathology sees 9% cut in 2021 MPFS Final Rule

After a lengthy delay, CMS released the 2021 Medicare Physician Fee Schedule Final Rule Tuesday. It finalizes several telehealth flexibilities introduced during the public health emergency while also significantly overhauling reimbursements for evaluation and management (E/M) services.

Covid Billing

More bad news for revenue cycle operations amid the COVID pandemic

The health system shut downs that took place in April and May (and in some instances stretched further) are still having downstream effects on revenue cycle operations for many of our clients. Unfortunately, we are seeing multiple issues because of this.

CMS establishes $28 Medicare rate for eventual COVID-19 vaccine

In an effort to be prepared to hit the ground running once a COVID-19 vaccine is made publicly available, CMS released an interim final rule with comment period late Thursday that sets the Medicare payment rate for administering a single dose at $28.39.

Phase 3 of HHS Provider Relief Fund opens Oct. 5

Providers still reeling financially from the COVID-19 pandemic will have another opportunity to apply for financial assistance through the HHS Provider Relief Fund beginning Monday, Oct. 5 when the program launches its third phase.

Covid Billing

As UHC limits OON lab services, questions arise surrounding timing

At a time when patients and providers alike are being severely impacted by the COVID-19 Public Health Emergency, UnitedHealthcare (UHC) has taken the opportunity to push some aggressive policy changes to limit care -- all while reaping record profits.

Are pathology cuts justifiable as we expand telehealth?

Can it be argued that these cuts may be premature? Could it be by 2021 that seeing your family doctor virtually will be the norm? Consider that the overhead costs for virtual medicine are considerably less than for actual face-to-face encounters.

Is pooled testing the solution for your lab?

At a time where the nations laboratories are continuing to struggle with meeting the COVID-19 testing demand, some officials have recommended the strategy of pooled testing as a means to cut down on the overall testing cost and workload.

Vachette weekly update — 8/3/20

This week, Vachette and Stark Medical Auditing CEO Mick Raich discusses a number of COVID-19 related issues, including what the extension of the Public Health Emergency means for ordering tests.

Vachette news and COVID roundup — 7/27/20

This week, Vachette CEO Mick Raich discusses the continued push for hospital price transparency, outlines the penalties you could face if your COVID-19 testing cash price isn’t listed publicly on your website and examines a few other COVID-related reimbursement issues.

Clinical Pathology service as backbone of an Anatomic Pathology group

Strong clinical pathology service is the foundation of a good health system relationship. This is the premise on which Tony Kubat, M.D., the President of Michigan Pathology Specialists, leads his 26-person pathology group in working with Spectrum Health System in Western Michigan.

Vachette news and COVID-19 roundup — 7/20/20

With Covid-19 showing no sign of slowing down in the near future, many health care providers need to prepare for a potential resurgence this fall that could lead to another pause on elective surgeries or a more comprehensive nationwide shutdown.

COVID-19 is not done impacting your revenue

With the next round of COVID-19 infections making the news, we are seeing some states and health systems closing down elective surgeries again. This will drastically affect health care providers as many are only now seeing cash return to pre-COVID levels, while others are still struggling to get their cash flow back in line.

Paying for referrals equals federal investigation

As it is alleged, this lab paid people to send their COVID tests to their lab. Needless to say, this is an obvious violation of anti-kickback laws and you can expect the DOJ will throw the book at those involved in the scheme when their investigation concludes.

HHS clarifies data labs must submit for COVID-19 testing

Last week, the Department of Health and Human Services (HHS) issued additional guidance for labs and other entities performing COVID-19 testing regarding exactly what demographic data is required to be submitted to local health authorities. While these requirements...

Watch for bad billing practices due to COVID fallout

Lately, we have found several clients with issues surrounding claims submission. These issues include duplicate billing, failed submissions to clearinghouses and unworked front-end edit reports.

How COVID-19 could drive surprise billing changes

While the discussion surrounding a nationwide solution for surprise billing was a hot topic until earlier this year, there are now many legitimate questions to be asking about how COVID-19 may drive the push for new legislation.

The train wreck effect COVID-19 has had on medical billing

As billing ramps up and billing entities are working on charge capture and getting bills out the door, the focus on old denials and working claims will be on the back burner. Don’t allow your billing dollars to be written off in a cleanup attempt this fall.

Webinar recording: Laboratory and Pathology billing in the time of COVID

As the nation begins to slowly recover from the COVID-19 public emergency, the Vachette team is reaching back out to the laboratory and pathology community to offer another free webinar with updates on the latest billing, payment and coding issues that have arisen in recent months.

How health care billers are responding to the COVID-19 pandemic

While there have been numerous discussions and looks into how the COVID-19 public health emergency is impacting hospitals and health care providers, very little has been said about how the billing companies who handled revenue cycle management for these individuals and entities are responding to this unprecedented situation.

Coding and billing COVID-19: A step-by-step guide

As CMS and the AMA continue to develop new codes for performing and billing COVID-19 testing, we will work to update you with the latest information to ensure you're being reimbursed properly during the ongoing public health emergency.

New serologic testing codes for COVID-19 published by AMA

As part of an expedited move to address the clinical need to report and track antibody testing related to COVID-19, the American Medical Association has revised one code and established two new codes to provide increased specificity to report serological lab testing.

Medical billing metrics to watch during the COVID-19 emergency

Although many practices will see a decrease in gross charges from the temporary hold on elective surgeries, this does not mean you should lose revenue to your practice at a larger percentage than the corresponding decrease in volume.

COVID-19 billing and coding primer

As part of a developing response to the COVID-19 pandemic, CMS and the American Medical Association have each issued billing codes for reporting COVID-19 related lab tests. Here’s a quick rundown of the key items to know when performing and billing for these tests.

CPT coding guidance for COVID-19 issued by AMA

The American Medical Association recently issued CPT coding guidance for COVID-19 related testing. The document includes both a clinical description of procedure code 87635, as well as the expanded definition of the procedure.

Who's reviewing revenue strategy with you at this time?

Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. We will review your Fee Schedule/Charge Master at no cost.

That’s right. For free.

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