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.
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.
Cigna to continue paying professional component of clinical pathology
After previously stating its intent to stop paying the professional component of clinical pathology, Cigna has reversed course and will continue paying for these services, according to CAP.
Case study: A/R collection strategy leads to $120k in recovered payments
Recently, Vachette was hired by a laboratory client under new management to review their outstanding accounts receivable (A/R). The goal was to assess the full scope and realistic collectability of their outstanding payments, while at the same time analyzing the...
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.
Cigna to cease payment for professional component of clinical pathology
Cigna, one of the last remaining payers that reimburses for the professional component of clinical pathology, will look to officially end that practice this summer, according to an update posted April 12.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
Pathology Charges, Payments and Salary Trends in 2016 — White Paper
This white paper will look at pathology compensation as of December 2016. I have done this review several times throughout the past 14 years of my career to shine a spotlight on the “real” compensation of pathologists.
White Paper: Preparing for the Merit-Based Incentive Payment System
Check out our free whitepaper to learn the potential financial impact the Merit-Based Incentive Payment System will have on providers, who is exempt from the program, when CMS is expected to finalize the rules governing MIPS, and much more!
White Paper: Business Strategy for Pathology Practices and Independent Laboratories
Vachette President Mick Raich recently spoke at the G2 PathForward Symposium, touching on issues such as mergers and acquisitions, the ACO movement, revenue, and managed care changes. The main points of this presentation are now available in a new white paper.
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.