Vachette Pathology

Many pathologists and laboratories are suffering from a simple lack of revenue management. Your payments will get worse if you choose to do nothing. You need to start auditing your billing and collection process and negotiate for more revenue.

Vachette Pathology is a pathology and laboratory practice management and hospital consulting firm. We currently manage over 50 pathology and laboratory practices coast-to-coast. They range from single man pathology practices to independent laboratories to 35 hospital based practices. Our Practice Managers have extensive experience in the field of hospital and laboratory billing. We can help to increase your revenue and secure your income.

There are several issues on the table for 2012:

• The pay cut for the 88305-TC
• The SGR 27.4% pay cut across the board
• RAC Audits
• ACO’s

Let’s take a look at how these will affect us: 

The pay cut for the 88305-TC is most likely going to take place. This CPT code has been increased steadily since 1996 also there has been a tremendous increase in the volume of this code by non-pathology groups.  With these biopsy volumes spinning out of control everyone is calling for a halt.  The best way to do this is lower the payment which in turn will decrease motivation.  Let’s play this out a bit.  If this CPT code is lowered many non-pathology groups will see their margin wither and die: this work may then return to both hospitals and independent labs.  Whether or not they can make a margin doing this work becomes their problem.  That is a whole different issue.  The good news is that many hospital based pathologists will find their work load increasing.

Have you received noticed from your MAC (Medicare Administrative Contractor) that it’s time for you to revalidate your enrollment information? If you enrolled with CMS prior to March 25, 2011, you will be receiving notification soon!

More in-office labs are getting CAP accreditation even though the College of American Pathologists is vigorously lobbying Congress to exclude anatomic pathology from the in-office ancillary services exception to the Stark rules that prohibit self-referral. CAP states that when physicians order on the basis of financial interest, there is enormous potential for over-utilization of testing.  Ironically though, more and more labs are getting CAP accreditation.

CAP clarifies its position on In-Office labs in October’s issue of Laboratory Economics…

As you know, CMS has employed several types of Review Contractors to review and recoup improper payments each year. The Contractor’s role is to review, measure, prevent, identify, and correct any improperly paid claims. This is done by selecting a sample of claims, requesting medical documentation from the provider who submitted the claims, and manually reviewing the claims against the medical documentation to verify the provider’s compliance with CMS rules.

The average national payment for 88305TC is $69.95 and the typical cost for the service is roughly $18 per an outline of the proposed physician fee schedule for 2012. CMS has requested that the AMA’s Relative Value Upscale Committee review the direct practice expense (PE) and the work values for this portion for the bread and butter code of pathologists and labs. This committee, which is comprised of 29 doctors, has a powerful influence on Medicare’s payment rates. Since their 1991 inception, they have submitted over 7,000 recommendations to CMS on the value of physician work and CMS has accepted more than 94% of them.

Medicare Gets the Best Price?

Surprisingly, the answer is no!