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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.

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.

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.

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: 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.

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?

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.

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.

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.

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.

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.

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.

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.

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 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.

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