Latest News
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.
Is pooled testing the solution for your lab?
At a time where the nations laboratories are continuing to struggle with meeting the COVID-19 testing demand, some officials have recommended the strategy of pooled testing as a means to cut down on the overall testing cost and workload.
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.
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.