he Covid-19 Public Health Emergency has been extended for an additional 90 days after HHS Secretary Xavier Becerra signed off on the extension Monday.
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.
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.
UnitedHealthcare announced Thursday it is delaying implementation of its Lab Test Registry "until further notice" due to Covid.
Health care providers who received distributions from the Health and Human Services Provider Relief Fund during the Covid-19 Public Health Emergency now have instruction on how to report on the use of those funds after HHS published new rules Friday.
In an effort to get more Covid-19 vaccinations into the arms of the general public, the Biden Administration announced Wednesday that Medicare payments for in-home vaccinations will be nearly doubled from the current rate.
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.
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.
The American Hospital Association (AHA) has formally asked HHS to extend the timeframe for providers to spend relief funds past the existing June 30 deadline.
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).
Beginning June 1, UnitedHealthcare (UHC) will manage its Genetic and Molecular Lab Testing Prior Authorization program through the UHC Lab Test Registry.
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.
Groups who accepted a Covid-19 Medicare accelerated or advance payment last year should soon begin seeing repayments deducted unless they've return the loan already.
CMS announced MACs are being instructed to hold all claims with dates of service of April 1 or later in anticipation of Congress extending the 2% sequestration suspension for the remainder of 2021.
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.
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.
What are the greatest challenges pathologists have experienced in the revenue cycle management world this past year-plus since the Covid-19 Public Health Emergency began?
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.
CMS has announced it will automatically extend its EUC policy to all 2020 MIPS clinicians who have only submitted limited data.
This webinar is now available to view free on-demand.
Timely filing extensions for claim submissions that were instituted last March as part of a Covid-19 National Emergency declaration are set to expire April 30, barring another extension.
CMS issued guidance Friday reminding providers and insurers that almost all instances of Covid-19 diagnostic testing must be covered without cost-sharing obligations throughout the PHE.
When re-testing Covid-19 specimens to check for variants, Medicare has indicated you may bill U0004 for the second-run test.
As part of the Biden Administration's effort to expand Covid-19 testing, HHS is seeking labs who can assist in expanding testing to K-8 schools and underserved populations in the coming months.
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.
The following Covid-19 coding changes are effective as of Jan. 1, 2021:
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.
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.
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.
Happy New Year! In his first update of 2021, Vachette and Stark Medical Auditing CEO Mick Raich unpacks the details of the latest COVID relief package passed by Congress, including a payment bump for the Medicare Physician Fee Schedule.
The CDC has implemented additions to the ICD-10-CM that are effective Jan. 1, 2021 for conditions resulting from COVID-19.
COVID relief and appropriations package includes surprise billing fix, $3 billion for provider relief
Congress signed off on a $2.3 trillion spending package late Monday that includes funding appropriations for the 2021 fiscal year and also includes an additional $900 billion for COVID-19-related relief efforts.
Vachette and Stark CEO Mick Raich dons his Santa gear to unpack the lump of coal that is the finalized 2021 Medicare Physician Fee Schedule
Providers anxiously waiting for additional government funding to offset pandemic-related losses received a salve Wednesday when HHS announced it is now distributing more than $24 billion in Phase 3 Provider Relief Fund payments.
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.
This week, Vachette CEO Mick Raich reviews a number of topics we covered in our most recent webinar, including when it is appropriate to bill the Uninsured Patient Portal when performing Covid-19 testing, how these rules pertain to instances of workplace screening, and more.
The American Medical Association has published a host of new CPT codes to cover the yet-to-be-released COVID-19 vaccine.
Some clarification has been offered as to how CMS expects providers to determine whether they're eligible for the COVID-19 add-on payment beginning Jan. 1.
Click here to watch our latest webinar free on demand.
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.
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.
In his latest update, Vachette and Stark Medical Auditing CEO Mick Raich reviews Medicare’s recent move to lower COVID-19 test payments for labs that don’t produce results within 48 hours and the impact that may have on labs moving forward.
CMS now appears to be tightening the reins on spending with new rules ostensibly designed to prevent fraud and abuse – and you can bet commercial payers will soon gladly follow suit.
Beginning Jan. 1, 2021, CMS will only pay the $100 high-throughput rate to labs that complete testing within two calendar days of the specimen being collected.
CMS recently issued 171 cease-and-desist letters to labs who did not have proper CLIA certification in place to perform COVID-19 testing, or were performing testing beyond the scope of their certification.
The Medicare Advance and Accelerated Payment Program is being modified to give borrowers a bit more flexibility in repaying their loans.
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.
In this week's video, Vachette CEO Mick Raich turns his attention to how the upcoming Presidential election between Joe Biden and Donald Trump.
After a weeks-long delay, HHS has finally published detailed reporting requirements for Provider Relief Fund (PRF) recipients who accepted one or more payments exceeding $10,000 in total.
Upon having conversations with our clients and colleagues in both the Noridian and Palmetto MACs, it has come to our attention that there is confusion in regards to reimbursement as it pertains to mutliplex NAATs for Respiratory Viral Panels.
Vachette and Stark Medical Auditing CEO Mick Raich reviews a Medicare policy change for ABNs and looks forward to how the ongoing COVID-19 Public Health Emergency will continue to impact health care providers in concert with the upcoming flu season.
Several questions surrounding COVID-19 testing and reimbursement for the fall of 2020 make us all stop and think. What happens if the public health emergency ends on Oct. 23?
Beginning Sept. 1, If a Medicare patient has been diagnosed with COVID-19 and is admitted to a hospital, the hospital payment is increased by 20%
As part of a new interim rule issued to clarify COVID-19 data reporting requirements, CMS also outlined the monetary penalties entities that fail to do so may face.
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.
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.
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.
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.
Many of the nation’s pathology groups receive a payment for being the Medical Director of their hospital laboratory. However, the recent COVID situation has caused a few issues to arise.
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.
As we work our way through the COVID-19 crisis, some of our practices and health systems are bracing for a tough fall season.
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.
The Department of Health and Human Services (HHS) released guidance Monday stipulating that providers who received more than $10,000 in Provider Relief Fund (PRF) payments will need to complete financial reporting to indicate how the money was spent.
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.
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.
Webinar recording: How COVID continues to impact labs amidst shifting payer policies and government regulations
This was Vachette's third free COVID-19 payment and reimbursement update. The free recording is now available.
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.
In his latest video, Vachette CEO Mick Raich shares his thoughts on what potential liability labs may face if they fail to report this data:
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...
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.
Hospitals across the country are experiencing monumental losses. Perhaps now is the time to chat with your administrators about ideas that can help generate revenue.
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.
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.
On Tuesday, CMS released the long awaited payment rates for two commercial coronavirus serological testing codes published last month by the American Medical Association.
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.
The Small Business Administration issued an FAQ last week clarifying the process that allows applicants to certify their Paycheck Protection Program loan requests were made in good faith.
Our initial COVID revenue projection showed revenue dipping quickly in April, but in reality, it looks like the true damage wasn’t done until May.
This is a time of financial struggle for many laboratories and pathology practices and it’s unconscionable to see firms charging for these funds. It is flat out price gouging.
While some states are still shut down and others just starting to open up, the question needs to be answered, how is my laboratory or practice doing compared to others?
HHS announced May 7 that it is extending the deadline to accept provider relief Medicare payments that were issued last month from 30 to 45 days.
Medicare providers who have already received a payment from the Provider Relief Fund are now eligible to apply for additional funds by submitting data about their annual revenues and estimated COVID-related losses via the Provider Relief Fund Application Portal.
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.
As the country looks to gradually open back up as state's adjust their COVID-19 responses, we will look to keep you updated on the latest guidelines regarding elective surgeries and more.
President Trump signed a $484 billion interim supplemental bill on Friday that provides additional emergency funding to aid the COVID-19 response.
With non-stop updates about Coronavirus testing and the pandemic in which we find ourselves, the business of your lab is still paramount to your survival.
New York Gov. Andrew Cuomo announced yesterday that the state is directing health insurers to provide cash-flow relief and ease administrative requirements for New York hospitals during the ongoing COVID-19 response.
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.
Medicare will pay $100 for COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity and faster results.
As part of the latest round of grants approved under the CARES ACT, Medicare providers began receiving a direct deposit stimulus payments from the Department of Health and Human Services on Friday.
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.
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.
Miss the webinar? The recording is now available!
The program will provide cash-flow assistance through 100 percent federally guaranteed loans to employers who maintain their payroll during the current COVID-19 public health emergency.
We have developed a revenue model called the COVID CURVE. We can easily and quickly import your last three months of billing revenue into the model to give you an idea how your next three months will look.
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.
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.
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