Latest News
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.
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.
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.