Vachette Pathology

To learn more about the trends that are affecting your income, mark your calendar for our 5^thAnnual Breakfast Workshop at CAP 10 Sunday September 26 at 6:30am at the Hyatt Regency Chicago in Columbus Hall KL, East Tower, Gold Level. FREE DONUTS AND COFFEE. WALK-INS WELCOMED. Drop in and listen to Mick Raich speak about the business of pathology and what you need to know to secure your financial future.

Mick Raich will provide real world examples of pathology practice and independent laboratory business issues and concrete solutions to help enhance the revenue of your practice. 

• Halt of in-sourcing of pathology specimens by nonpathologists
• Managed care payments and denial trends
• Roaring Fork Valley Physicians IPA Inc. case
• Changes in the pathology and laboratory billing world
  

We look forward to seeing you there. Visit us at booth # 223 and learn how we can assist you and your practice. 

A recent news story about pathology reports being found in a dump made me smile. See The Boston Globe 8/13/2010. The first thought that came to my mind was that some pathology group cancelled their contract with their biller and now the biller was cleaning out the cabinets. 

Obviously this was a distinct violation of HIPAA and not very professional. The whole thing made me think about what happens when you terminate your billing service. How are they supposed to treat you? How do you move through this process in a professional way?

In my position, we are often brought in to work with groups that are moving through this process. They are unhappy with their current billing service. Often the reasons for this dissatisfaction are the same. The billing service keeps changing service representatives and there is no longer a personal relationship, the billing service was sold to another company and all the players have changed, or the biller is not providing quality service, i.e. the cash flow is declining.  It doesn’t matter the reason. The bottom line is that this is a business divorce and like many divorces it can get messy. 

Congress creates a $19 billion subsidy program

Early in 2009, Congress passed the American Recovery and Reinvestment Act (ARRA) which created a $19 billion subsidy program to help physicians and hospitals purchase electronic health records (EHR) systems. For many physicians, the cost of an EHR has simply been out of reach. The new program, therefore, provides an opportunity to enter the digital era. As with any government subsidy program, however, there are strings attached.

CMS and the ONC develop criteria

While the law broadly laid out the parameters under which physicians could receive these incentive payments, the specific rules that will govern the program are developed by the administration.

With 21% cuts in Medicare physician payment looming for June 1, the US House of Representatives is expected to consider legislation that would provide for modest increases and/or freezes in physician payments for the next four years. The proposal is being incorporated into H.R. 4213, The American Jobs and Closing Tax Loopholes Act of 2010, and might be considered by the US House as early as Tuesday, May 25. Specifically, the language included in H.R. 4213 would provide for:

• a 1.3% update in Medicare physician reimbursement for 2010;
• a 1% increase in 2011; and
• updates in 2012-13 updates based on target expenditures, which, at worst, would freeze payments for the two years.

In 2014, Medicare physician payment would, once again, be subject to the Sustainable Growth Rate (SGR) formula. Some projections have indicated that Medicare physician payment might be cut by 32%, at that time.

Tonight, the senate passed legislation to extend the “freeze” in the 21% SGR fee schedule cut. The freeze was in effect since 1/1/10. This new freeze will be in effect through the end of May. The House of Representatives was expected to remain in session tonight and after the House passes the bill, it will go immediately to the President and he has indicated he will immediately sign the bill. 

CMS announced earlier today that they no longer had the authority (statutory authority) to delay payment of the provider claims and approved the Contractors to begin processing the oldest claims first. There will be some testing of the system prior to processing, so it is possible that some claims could be paid at the reduced rate. If this occurs, the contractor will automatically reprocess the claim if it was Pre-April 1 and pay the differential owed to the provider. 

There are continued lobbying efforts to put in place a permanent fix for this persisting problem and we will keep you updated on them.

For more information visit www.compone.com.

A 21.2% Medicare pay cut will take effect April 1 after the Senate failed to pass a bill on Friday March 26 extending the effective date to May 1 before lawmakers recessed for 2 weeks.

When Congress returns to work April 12, Senate Democrats will try to pass the 1-month extension again and make it retroactive to April 1.

The 21.2% reduction in reimbursement taking effect on April 1, 2010 does not necessarily mean that physicians will experience the Medicare meltdown everyone is predicting. When Congress goes back to work on April 12, Senate Democrats will try to pass the 1-month extension again and make it retroactive to April 1. The Centers for Medicare and Medicaid Services has announced that it will freeze payments on physician Medicare claims for the first 10 business days of April and then pay the full amount — as if the reduction never occurred — if the 1-month extension passes in the Senate.