Latest News
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, survey now available
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.
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.
New Stark Law rules create safe harbors to promote value-based care, telehealth
A pair of Final Rules issued recently by CMS and the OIG establishes new safe harbors aimed to promote value-based care, while also modifying some of the existing safe harbors.
UHC again delays lab test registry rollout to Jan. 1, 2022
UnitedHealthcare (UHC) has recently announced it will delay the implementation of its new lab test registry that will require labs to provide unique test codes on claims for in-scope services to Jan. 1 2021.
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.
New information blocking regulation goes into effect April 5, 2021
The new rules take effect beginning April 21, 2021, and primarily apply to Certified Electronic Health Record Technology (CEHRT) but not laboratory information systems (LISs).
2019 MIPS stats reveal small bonuses, strong participation
CMS recently unveiled its analysis of 2019 QPP participation, again revealing another year of strong buy-in from clinicians that resulted in miniscule bonuses for their trouble.
Michigan latest state to enact surprise billing law
Michigan has become the latest in a string of states that have elected to tackle the issue of surprise billing after a number of federal bills to address the issue have stalled out or lost traction in recent years.
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.
MolDX removes coverage for BioFire, GenMark respiratory panels
As of Oct. 1, MOLDX has updated their LCDs/Billing and Coding Articles for the Multiplex Nucleic Amplified Tests for Respiratory Panels to no longer cover the PLA codes 0098-0099U, U100U, and 0115U. These PLA codes represent respiratory panels using BioFire® or GenMark® platforms.
Preparing for price transparency, UHC G0416 change and more — Vachette update 10/7/20
This week, Vachette CEO Mick Raich reviews the hospital price transparency rules that will take effect Jan. 1 and outlines why they may not be a big deal for larger health systems.
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.
Hospital pricing transparency starts January 1 — here’s what to know
Despite pushback from numerous hospital and provider advocacy groups, CMS appears set to move forward with plans to require hospitals to disclose their service pricing beginning Jan. 1, 2020.
Watch for limits on genetic testing as CMS looks to rein in spending
A recent edition of Laboratory Economics (Volume 15, No. 9, September 2020) featured an article examining the Office of Inspector General's (OIG) recent report detailing how genetic testing is driving an increase in Medicare spending on the Clinical Laboratory Fee Schedule (CLFS).
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.
88342 Optum denials: How Vachette advocates for the lab and pathology industry
The latest in our string of successes comes from working with Optum Medicare Advantage. It seems they were denying 88342-26 for needing a preauthorization as a molecular code.
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%
Illegal kickbacks, Covid payment boosts and more — CEO Q&A 8/31/20
Vachette CEO Mick Raich addresses a number of questions our team has recently received in this Q&A.
UHC issuing recoupments on 88305 prostate biopsies for Medicare Advantage members
Several clients recently informed us UnitedHealthcare (UHC) has issued refund requests to recover 88305 payments for prostate biopsies performed on Medicare Advantage members throughout the past six months.
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.
Vachette weekly update — 8/17/2020
In his latest update, Vachette and Stark CEO Mick Raich explores a number of new policy changes from UHC that are continuing to hurt labs during a vulnerable time.
Final 2019 MIPS scores now available, targeted review deadline Oct. 5
Finalized scores for the 2019 Merit-based Incentive Payment System (MIPS) performance year are now available to review online through the Quality Payment Program (QPP) portal.
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