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Opinion: Is healthcare set to face a pandemic bubble?
In 2020 and early 2021, more than $4 trillion was pumped directly into society, including funding for healthcare providers and facilities. While most Americans spent last year wondering if the world was collapsing, healthcare had one of its best years ever.
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.
Opinion: Cigna PC/CP decision likely a temporary reprieve
So, what does this recent development actually mean? Most likely, Cigna will slowly and by degrees stop paying for the professional component of clinical pathology.
Webinar: Strategies for getting your laboratory in-network
Struggling to get your lab in-network as commercial payers continue to tighten their networks? Sign up for Lighthouse Lab Services next webinar to learn how to break through this difficult process!
Case study: Insurer holding payments over tax ID confusion
It has recently come to our attention that a large national health plan is denying payment for a pathology group due to confusion over their tax ID number.
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.
Cigna to continue paying professional component of clinical pathology
After previously stating its intent to stop paying the professional component of clinical pathology, Cigna has reversed course and will continue paying for these services, according to CAP.
Case study: A/R collection strategy leads to $120k in recovered payments
Recently, Vachette was hired by a laboratory client under new management to review their outstanding accounts receivable (A/R). The goal was to assess the full scope and realistic collectability of their outstanding payments, while at the same time analyzing the...
OIG identifies $3.4 million in Medicare Advantage overpayments to Anthem
The HHS OIG recently revealed CMS overpaid Anthem about $3.4 million in Medicare Advantage payments due to the payer failing to meet federal coding rules.
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.
Webinar: Diving in on buy-sell agreements and maximizing AR
We recently welcomed Dr. Stephen Ruby, MD, MBA, FCAP, to discuss the importance of having a buy-sell agreement in place for your lab or practice and how your accounts receivable factors in to that discussion.
PAMA data reporting could be simplified under MedPAC proposal
Laboratories dreading the next round of PAMA private payer data reporting may see some administrative relief if a recent MedPAC proposal aimed at reducing the reporting burden is adopted by CMS.
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).
Crime beat: Recent laboratory fraud review
In his latest video, Vachette President Mick Raich reviews a handful of high profile instances of fraud and abuse within the laboratory industry
A path forward as Cigna ends PC clinical pathology payments
Recently, Cigna announced it will longer going to pay for the professional component of clinical pathology (PCCP) beginning July 11. This comes as no surprise; we have seen this coming for the past few years as UnitedHealthcare, Humana and Aetna have made similar moves.
Cigna to cease payment for professional component of clinical pathology
Cigna, one of the last remaining payers that reimburses for the professional component of clinical pathology, will look to officially end that practice this summer, according to an update posted April 12.
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.
Press Release: Lighthouse Lab Services Acquires Nation’s Premiere Pathology and Laboratory Revenue Cycle Auditing Firm, Vachette Pathology
At the beginning of April, North Carolina-based Lighthouse Lab Services is proud to announce its acquisition of Vachette Pathology of Sylvania, Ohio.
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.
CAP offers update on UHC DDP program
Although United Healthcare's Designated Diagnostic Provider Program (DDP) is set to launch July 1, many labs who will be affected by the move to restrict outpatient lab payments for diagnostic services to a select group of in-network providers are still seeking...
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.
AP/CP pathologist sought by OSF Healthcare
OSF Healthcare (Rockford, Ill.) is seeking a Board Certified Anatomic & Clinical Pathologist. Hematopathology training preferred.
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.
Surgical pathologist sought by private practice group
Advanced Diagnostic Pathology Associates, a physician-owned private practice group of four pathologists, is seeking a Surgical Pathologist with strong general pathology skills, the ability to handle high case volumes and excellent communication skills to join their rapidly expanding practice.
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.
UHC to require Designated Diagnostic Provider status for non-patient payments
Beginning July 1, 2021, UnitedHealthcare will only cover outpatient diagnostic lab services for commercial members when performed by a Designated Diagnostic Provider
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.
AHA data shows Medicare, Medicaid payments off true cost by $76 billion in 2019
According to recent data from the American Hospital Association (AHA), hospitals received 87 cents for every dollar they spent caring for Medicare patients and 90 cents for every dollar on Medicaid patients in 2019.
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.
UHC to expand genetic/molecular lab prior authorizations April 1
In a recent provider bulletin, UHC announced it will expand the list of CPT codes included in its Genetic and Molecular Lab Testing Notification/Prior Authorization program for commercial members starting April 1, 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.
Ohio surprise billing law set to take effect next year
On Friday, Jan. 8, Ohio Gov. Mike DeWine signed new surprise billing legislation into effect that pays for out-of-network (OON) services at 100% of the Medicare rate or the median in-network rate.
UHC now requiring G0416 for prostate biopsies across all products
After making the move to align prostate biopsies with G0416 for Medicare Advantage plans earlier this year, UnitedHealthcare has announced the policy will be put into effect for its commercial products beginning Jan. 1, 2020.
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.
Anthem reportedly undergoing Georgia DOI market conduct review, reports MAG
The Medical Association of Georgia (MAG) is reporting that the Georgia Department of Insurance (DOI) may be conducting a review of Anthem's conduct within the state.
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.
No Surprises Act aims to provide national surprise billing fix
After years of back and forth discussion, a national surprise billing fix could soon be implemented as part of Congress's annual funding package.
Panel of National Pathology Leaders seeking input for 2021 virtual roundtables
The Panel of National Pathology Leaders (PNPL), a national non-profit thinktank dedicated to advancing best practices in pathology and laboratory medicine, is soliciting input on a series of monthly pathology management roundtables to be held throughout 2021.
Career Opening: Medical Billing Auditor
Vachette is seeking a Medical Billing Auditor to join our team! This position will be responsible for reviewing specialty specific reporting to ensure proper coding and billing guidelines are met by clients and billing agencies.
Career Opening: Client Administrator
Vachette is seeking a Client Administrator to join our team! The Client Administrator is the main point of contact with the physician, group, hospital administration, or directors for any of our clients that are being managed.
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.