COVID-19 Resources and News
Covid-19 Public Health Emergency extended again
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.
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.
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.
UHC indefinitely delays Lab Test Registry
UnitedHealthcare announced Thursday it is delaying implementation of its Lab Test Registry "until further notice" due to Covid.
HHS sets reporting, spending deadlines for Provider Relief Fund payments
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.
Medicare nearly doubles payment for at-home Covid-19 vaccinations
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.
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.
AHA seeks extension as HHS relief fund spending deadline approaches
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.
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).
UHC Lab Test Registry to manage genetic, molecular test prior authorizations beginning June 1
Beginning June 1, UnitedHealthcare (UHC) will manage its Genetic and Molecular Lab Testing Prior Authorization program through the UHC Lab Test Registry.
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.
CMS recouping Covid-19 advances as of March 30
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.
MACs instructed to hold claims amid sequestration freeze
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.
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.
Video: The biggest RCM challenges pathologists have faced due to Covid
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 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.
CMS offering automatic 2020 MIPS exemption
CMS has announced it will automatically extend its EUC policy to all 2020 MIPS clinicians who have only submitted limited data.
Free webinar: What’s next for Covid labs? Testing and revenue strategy moving forward
This webinar is now available to view free on-demand.
Timely filing extension renewed alongside National Emergency declaration
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.
Biden Admin reaffirms Covid testing must be covered without cost-sharing
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.
Medicare clarifies billing rules for second run Covid-19 variant tests
When re-testing Covid-19 specimens to check for variants, Medicare has indicated you may bill U0004 for the second-run test.
HHS to expand Covid testing opportunities under new initiative
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.
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.
2021 Covid-19 coding update
The following Covid-19 coding changes are effective as of Jan. 1, 2021:
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.
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.
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.
Breaking down the latest COVID relief, U0005 usage and more — CEO update 1/12/21
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.
New COVID diagnosis codes now in effect
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.
Preparing for 2021 Medicare cuts — CEO update 12/21/20
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
HHS distributing $24 billion in Phase 3 Provider Relief Funding
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.
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.
CEO update: Billing the COVID Uninsured Patient Portal and other testing compliance issues
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.
AMA publishes COVID-19 vaccine CPT codes
The American Medical Association has published a host of new CPT codes to cover the yet-to-be-released COVID-19 vaccine.
CMS clarifies rules for U0005 COVID add-on payment
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.
Webinar recording: Collecting your COVID billing amid new rules, payment cut
Click here to watch our latest webinar free on demand.
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.
Video: How will Medicare’s move to adjust COVID-19 test payments affect labs?
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.
Host of recent COVID-19 testing rules seek to complicate reimbursement
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.
CMS adjusts Medicare COVID-19 test payments to boost turnaround times
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 cracks down on labs performing COVID-19 testing without CLIA certification
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.
Congress grants Medicare Advance borrowers more time to repay, lower interest rates
The Medicare Advance and Accelerated Payment Program is being modified to give borrowers a bit more flexibility in repaying their loans.
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.
Looking ahead to the election and its impact on healthcare — Vachette weekly update 9/23/20
In this week's video, Vachette CEO Mick Raich turns his attention to how the upcoming Presidential election between Joe Biden and Donald Trump.
HHS releases reporting requirements for relief fund payments
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.
LCD causing issues surrounding reimbursement for respiratory viral panels during PHE
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.
How the PHE will affect healthcare this fall — Vachette weekly update 9/17/20
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.
With reimbursement changes looming, questions surround future COVID testing
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?
Inpatient Medicare payments for COVID-19 patients to be boosted 20% Sept. 1
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%
CMS clarifies monetary penalties for failing to report COVID-19 results in new interim rule
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.
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.
Pathology group medical director complications caused by COVID-19
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.
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.
Four things to consider concerning health care revenue this fall
As we work our way through the COVID-19 crisis, some of our practices and health systems are bracing for a tough fall season.
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.
HHS offers timeline for provider relief fund reporting requirements
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.
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.
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.
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.
Labs struggling to collect COVID demographic data
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:
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.
Is it time for a joint venture with your health system?
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.
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.
Rates for coronavirus serological tests set by CMS
On Tuesday, CMS released the long awaited payment rates for two commercial coronavirus serological testing codes published last month by the American Medical Association.
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.
SBA offers clarification on PPP loan forgiveness, certification
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.
Reassessing our COVID medical billing impact predictions
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.
Some billers charging to process COVID relief funds
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.
How does your COVID billing compare to others?
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 extends deadline to accept stimulus payment
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.
HHS allocating additional funding to providers via application process
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.
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.
Complete rundown of state stay-at-home orders, elective surgery timelines
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.
Latest COVID stimulus round replenishes PPP, adds funds for lab testing
President Trump signed a $484 billion interim supplemental bill on Friday that provides additional emergency funding to aid the COVID-19 response.
COVID-19 revenue concerns to start anticipating now
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 directs insurers to ‘immediately’ process outstanding hospital claims, suspend prior-auth
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.
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.
CMS boosts payment, publishes new U-codes for COVID-19 testing using high-throughput tech
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.
HHS distributing stimulus payments to Medicare providers
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.
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.
Webinar: What pathology groups and labs need to know to weather COVID-19
Miss the webinar? The recording is now available!
Does your group qualify for the Paycheck Protection Program?
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.
A helping hand: understanding the COVID-19 billing curve
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.
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.