Latest News
Case Study: Regular Charge Fee Schedule Review
Setting up and regularly reviewing your charge fee schedule regularly is crucial to ensuring your practice is not leaving money on the table.
MIPS 2023: Reporting for Pathologists
CMS has announced what lies ahead for the Merit-based Incentive Payment System (MIPS) program with proposed adjustments for the 2023 performance year, which impacts Medicare Part B payments in 2025.
Cigna Again Postpones Reduction for PCCP Reimbursement
According to a recent letter, it now appears Cigna's plans to reduce PCCP payments to $5 when the professional/technical component indicator is 3 or 9 are on hold.
How the No Surprises Act is Hurting Pathology Revenue
Large insurance companies are now lowering their rates to pathology groups and using the rules of the No Surprises Act (NSA) to their advantage.
2023 Proposed Medicare PFS: See Impact to Pathology
The proposed conversion factor is $33.08, a decrease of $1.53 to the 2022 PFS conversion factor of $34.61. Both pathology and independent laboratories are expected to see their overall allowed charges drop by -1%.
New Digital Pathology Codes Announced for 2023
Last month, the American Medical Association CPT Editorial Board announced 13 new digital pathology add-on codes that will go into effect in January 2023.
2022 CPT Update: Clinical Pathology Consults
There will now be four new codes to differentiate pathology clinical consults in more detail than the previous two CPT codes (80500 and 80502).
No Surprises Act Frequently Asked Questions
The No Surprises Act (NSA) provides individuals and families covered by group and individual health plans protection against unexpected, high-priced medical bills for services delivered at in-network facilities by out-of-network (OON) providers.
Case Study: Prostate Biopsy Billing Issues
Not only was the issue resolved to reprocess 95 claims for an additional payment of $70,000, but the payor’s system also was corrected so that claims would pay correctly moving forward and the client would not continue to have underpaid claims.
OIG to Focus Audits on COVID Add-On Payments
The OIG has announced its intention to audit add-on payments for high-throughput technology made by Medicare for COVID-19 CDLTs. These audits are expected to begin in 2023.
CMS Accepting 2022 MIPS Exception Applications
CMS has announced it is now accepting MIPS Exception applications for clinicians and groups who have been impacted by public health emergency in 2022.
Lessons from Executive War College 2022
Every year the sky is falling, at least that’s how it seems. I have been attending Executive War College since the 90s and thank God we’ve been able to change and adapt with the dramas of running a healthcare business. These are things I learned from presentations by Robert Michel, editor-in-chief of the Dark Report, and others:
Items to Watch as the Public Health Emergency Winds Down
Due to a number of COVID funds being exhausted or close to tapped out, this is likely to be the final extension. Here are some items to keep in mind as labs and pathologists prepare for the potential end of the PHE.
UHC Moving Forward with Change Acquisition Amid DOJ Challenge
UnitedHealth says it plans to complete the acquisition of Change Healthcare despite an ongoing legal challenge from the Department of Justice (DOJ) that aims to block the deal.
Cigna to Cap PC Clinical Pathology Reimbursement at $5 Beginning July 1
Letters from Cigna dated April 1st, 2022, are not an April Fools’ Prank. It appears that Cigna is attempting a new additional tactic to manage their payment of the Professional Component of Clinical Pathology (PCCP).
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.