White Papers

Cigna again moves to end PC clinical pathology payments

After holding off on the move during the summer amid significant pushback from pathology and lab advocates, Cigna appears to again be moving forward with its plan to end reimbursement for the professional component of clinical pathology (PC/CP) beginning Nov. 1, 2021.

Covid Billing

A new managed care strategy for pathologists

The time has come for a new mindset. No longer should pathology contracts be tied to a draconian Medicare fee schedule hurtling towards the lowest payment possible.

2022 Proposed MPFS: See impact to pathology, labs

Pathologists and independent laboratories will experience a handful of significant payment reductions for key services if CMS adopts changes released Tuesday in the 2022 Medicare Physician Fee Schedule (MPFS) Proposed Rule.

Covid Billing

A path forward as Cigna ends PC clinical pathology payments

Recently, Cigna announced it will longer going to pay for the professional component of clinical pathology (PCCP) beginning July 11. This comes as no surprise; we have seen this coming for the past few years as UnitedHealthcare, Humana and Aetna have made similar moves.

Image by Jan Vašek from Pixabay

Covid vaccine billing FAQ

As the U.S. continues to ramp up its efforts to administer Covid-19 vaccines, many providers have been inquiring about the process for becoming eligible to compliantly bill for vaccines.

With that in mind, the Vachette team has put together a helpful FAQ that covers Medicare payments, how to become a Mass Immunizer, compliant roster billing and more. The full document (PDF) may be downloaded below.

2021 Medicare Fee Schedule boost: See impact to pathology services

As part of the COVID relief and and appropriations package signed into effect Dec. 27, Congress took steps to mitigate significant fee schedule reductions for several specialties that were designed to offset payment boosts for evaluation and management (E/M) services.

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.

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.

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 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...

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.

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.

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?

Identifying and preventing health care fraud

Instances of health care fraud account for billions of dollars of lost revenue a year throughout the industry. Without the correct safeguards installed to help identify and end fraudulent practices, health care providers could face investigations and penalties that could cost them significant amounts of revenue and threaten the financial health of their business.

Using FOIA to bolster Medicare Part A negotiations

When the time comes for hospital-based pathologists to negotiate their compensation rates for Medicare Part A payments received by their hospital, many are left scrambling for hard data while trying to determine a fair price for their oversight.

Understanding and navigating Medicare MUE, PTP edits

As with most CMS initiatives, it can be difficult to keep pace with the constantly evolving list of MUEs, especially when considering CMS and other carriers reserve the right to maintain a list of unpublished MUEs that providers and their billers likely won’t know about until they receive a denial.

Current Metrics in Medical Billing Contracts — White Paper

It’s no secret that as medical billing has become increasingly complex over the past decade, the contracts of third-party billers have followed suit. “There’s now a lot less risk in these contracts on the biller’s end,” says Mick Raich, President of Vachette Pathology. So, what's standard for these agreements in 2018?

What Could a Single-Payer Plan Mean for Pathologists?

How do pathologists fit into the changing health care landscape, and how would they adapt to a single-payer system if one were implemented? Vachette President Mick Raich offers his thoughts after taking a deep dive into the issue.

New Business Model for Medical Billing Companies

What can billing companies do to stay abreast of changes and shore up profit margins while retaining clients? Our new white paper looks at the current state of billing firms today, and then gazes through the looking glass at billing companies 10 years from now.

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.

Share This