Latest News
Pathology services slated for 9% cut in 2021 MPFS Proposed Rule
Overall, the rule shows pathology and independent lab services are scheduled to drop from 2020 rates by 9% and 5%, respectively.
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.
Job Opening: Coding and Medical Billing Auditor
Our dynamic auditing and consulting firm is searching for an experienced certified coding expert to join to our team.
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.
Job Opening: Client Administrator
Vachette is seeking a talented, highly motivated individual with an in-depth knowledge of practice management to join our team.
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.
West Virginia Laboratories seeking full-time billing statement specialist
West Virginia Laboratories is seeking the best Billing Specialist in the state to join their team. If you are looking to join an amazing company that is passionate about making a difference in our patients' lives, then West Virginia Laboratories is the place for you.
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:
Even the government knows providers can’t audit themselves
Ultimately, when we do review these self-audit sites, we find their error rates to be higher than the standard industry rate of 5 percent, sometimes as high as 20 percent. So why are some groups happy to continue down this route?
Understanding UHC’s lab test registry
Beginning Oct. 1, United Healthcare (UHC) will require labs to provide unique test codes on claims for in-scope services.
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.
Forecasting the next two to 10 years in health care
Let’s crystal ball the COVID-19 crisis over the next two years and then guess what will be the outcome in ten years and how this will affect the medical community.
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 pitfalls of the instant billing world
We often get these calls from groups or firms with a large amount of capital and very little knowledge of what it takes to get through the correct processes to get paid. Instead, they call us requesting magic.
Dissecting the HHS COVID-19 uninsured payment portal
Optum has built the Health and Human Services COVID-19 Uninsured Payment Portal, which allows providers to submit claims for uninsured COVID-19 patients.
Cigna to cease payment for 88305 prostate biopsies under new policy
In a recent letter to providers, Cigna announced it will no longer reimburse prostate needle biopsies billed with CPT 88305 beginning Aug. 18.
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.
UHC seeking to renegotiate legacy contracts in Texas
It appears another major payer is now seeking to rein in payments to pathologists and labs with long standing "legacy" contracts as UHC recently began issuing letters to providers in Texas informing them of upcoming fee schedule cuts.
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.
Florida Medicaid cuts several CP codes from fee schedule
For background, Florida is one of few states where Medicaid still pays for the PC of CP work. However, as of Jan. 1, many of the codes on the fee schedule that previously paid both the PC and technical component split now only include a rate for global payments.
How COVID-19 is affecting insurers
Everyone knows health care providers have been hit hard by COVID-19, but how have insurers been affected? Vachette CEO Mick Raich has the latest.
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.
Nevada lab seeking to fill local billing manager, national sales rep positions
MD Labs, a nationwide toxicology lab with headquarters in Reno, Nevada, is seeking to fill the following two positions:
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.
Medicaid waivers for 11 more states approved by CMS
The waivers offer relief on a number of fronts, such as prior authorization and provider enrollment requirements, suspending certain nursing home pre-admission reviews, and facilitating reimbursement to providers for care delivered in alternative settings due to facility evacuations.
2019 MIPS reporting deadline extended to April 30
CMS announced Sunday that the 2019 Merit-based Incentive Payment System (MIPS) reporting deadline has been extended from March 30 to April 30 to allow providers to focus on COVID-19 response.
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.
COVID-19 test pricing announced by CMS
CMS released pricing for COVID-19 testing for each Medicare Administrative Contractor (MAC) earlier today. The full list may be downloaded here:
Coronavirus and your medical practice revenue
With the current travel restrictions and changes affecting the country due to the new coronavirus (COVID-19), the question comes to mind: how will this affect my practice?
How hospital-based pathologists should approach Anthem rate cuts
While a number of different strategies have been employed, the results have been hit-or-miss at best, according to Ann Lambrix, Vice President of Client Services for Vachette Pathology.
How proactive auditing can prevent fraud
Billing items that aren't billable, collecting dollars that don't belong to them -- every day we see different examples of unintentional fraud that could be prevented through routine audits and proactive revenue cycle management.
How to preempt surprise billing law changes
It is happening. Just as predicted, we are seeing insurance plans cut contracts to hospital-based providers ahead of the passage of proposed surprise billing laws in Congress.
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.