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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.

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.

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.

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.

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.

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

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).

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.

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