Posts made in 2014

PQRS Pay Cuts – Notification Letters Issued

Posted by on Dec 2, 2014 in Latest News | Comments Off on PQRS Pay Cuts – Notification Letters Issued

FYI: CMS has begun issuing notification letters to providers who are subject to the 2015 Physician Quality Reporting System (PQRS) payment adjustment penalty. This penalty is assessed to providers who do not satisfactorily report data on quality measures for covered professional services. The letters were sent out the end of September, early October.  The penalty of 1.5% applied to Medicare payments in 2015 will be issued based on the provider’s reporting in 2013. Providers must note that the penalty will increase to 2% in 2016. If you are subject to the 1.5% penalty, it is imperative to ensure your processes for PQRS measures reporting are...

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New Business Model for Medical Billing Companies

Posted by on Nov 26, 2014 in Latest News, White Papers | Comments Off on New Business Model for Medical Billing Companies

By Mick Raich, President I’ve worked in the medical billing world for the past 20 years, both for billing companies and as the owner of an auditing firm. Never have I seen such rapid changes in the industry. Automation, outsourcing, and new workflow processes are driving these changes, with some billers struggling to keep up. 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. To download our white paper, please join our mailing list. We promise not to share your email or send you spam, and you can unsubscribe at any time. First Name (required) Last Name (required) Your Email...

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Webinar: Essentials for 2015 in Coding, Billing and Collections

Posted by on Nov 19, 2014 in Latest News | Comments Off on Webinar: Essentials for 2015 in Coding, Billing and Collections

Essentials for 2015 in Coding, Billing, and Collections for Clinical Labs and Pathology Groups Thursday, December 4, 2014—Save the Date! Are you prepared for the onslaught of coding, billing, and collection changes coming in 2015 relative to how Clinical Labs and Pathology Groups bill Medicare and private health insurers? Every lab that wants to do better at filing clean claims and getting faster payment must be prepared for these changes! “It will be a high-stakes game in 2015 because both government and private payers are stacking the deck against clinical labs and pathology groups,” says Robert L. Michel, Editor-in-Chief of The Dark Report. “Across the nation, Medicare carriers and private health insurers are implementing myriad changes in coverage guidelines and reimbursement for both clinical lab tests and anatomic pathology services, in an effort to reduce their costs. “There will be so many of these changes in how labs must code, bill, and collect during 2015 that, in a sense, the lab testing industry faces ‘financial death by a thousand cuts,’” continued Michel. “This makes it imperative that every lab’s billing and collections manager stay informed and be prepared for these changes.” The good news: There’s still time to gear up for these changes! Get quickly up to speed on the specifics, and what you need to do to ensure fair and accurate payment in 2015 by taking advantage of this timely webinar, entitled “Essentials for 2015 in Coding, Billing, and Collections for Clinical Labs and Pathology Groups” on Thursday, December 4, 2014 at 1:00 PM EST. YOUR PRESENTERS: Rina Wolf Vice President of Commercialization Strategies, Consulting & Industry Affairs XIFIN, Inc. Tom Scheanwald President and Chief Operating Officer APS Medical Billing Michelle Miller Vice President Vachette Pathology From the clinical lab side, we will tap the expertise of Rina Wolf from XIFIN. Rina is a nationally recognized expert in the field of laboratory reimbursement, and XIFIN is one of the nation’s largest companies providing revenue management and billing/collection services to labs. For anatomic pathology practices, we’ll draw on the insights of Tom Scheanwald from APS Medical Billing, and Michelle Miller with Vachette Pathology, with decades of combined experience in compliant coding and effective billing for the pathology lab industry. This panel of experts will present the essential changes coming in the clinical lab and anatomic pathology billing/coding/collection arena for 2015. They will discuss coming changes in Medicare, including the new final rules for the 2015 Medicare Physician fee update just published, as well as what is happening with private health insurers, ranging from UnitedHealthcare and Humana, to Blue Cross and Cigna, to name just a few. What better or more timely forum for you to prepare your lab leadership and your billing/collection managers with the absolute most up-to-date information about how the Medicare program and private health insurers will change policies in 2015 policies that will make it even tougher for labs to submit claims and be paid on a timely basis. Here’s just some of what you’ll learn during this information-packed 90-minute webinar: Learn which Medicare program changes are likely to have the biggest impact on your Medicare billing and collections during 2015 Understand the different ways that Medicare carriers will want your lab to submit claims during 2015, and how to best meet those requirements to ensure full and timely payment to your lab Know the specific new coding and billing requirements that will change at the nation’s largest health insurance companies during 2015 Benefits of training your lab’s coding/billing/collections team in advance of January 1, 2015, to handle lab test claims in ways that meet the new...

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Excelling at Productivity and Process Improvement

Posted by on Nov 19, 2014 in Latest News | Comments Off on Excelling at Productivity and Process Improvement

Vachette and Stark are committed to excellence, and part of that means education and continuous process improvement.  Recently we sent some of our team to Effective Personal Productivity training.  This entailed goal setting and time management.  We received this testimonial from the leader: “In my 30 years of leadership development and management training work, I’ve rarely come across a team whose members were so uniformly capable, articulate, hard-working, and purposeful while negotiating the challenging training experience we serve up to our clients. For real success with this training (and, for us, that means not only improved business results, but also genuine behavior change), our participants have to make their training experience a top priority; their leaders have to give them strong support as they move through the learning process; and they have to apply their learning to real problems and opportunities and make things different and better. Vachette / Stark gave us all that, and more.  They created real synergy among themselves.  Their combined learning effort brought about important organizational changes, changes that promise to help them stay in continuous improvement mode and to scale their company’s operations rapidly and effectively. It has been rewarding for me to be a part of these developments.” — Bryce Harbaugh, Co-Owner, Midwest Management Systems, Toledo, OH. I commend my team on a job well done; they will work hard to be diligent in using these new skills for both their own personal growth and the growth and management of our clients.  I am lucky to have such strong, smart and caring people on my...

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Medical Mutual of Ohio Denials on IHC

Posted by on Oct 21, 2014 in Latest News | Comments Off on Medical Mutual of Ohio Denials on IHC

By Jessica Jankowski, Executive Client Administrator Once again we find another carrier creating a policy reflective of the Local Coverage Determination (LCD) that was published recently by WPS Medicare. Medical Mutual of Ohio (MMO) created a policy effective July 2014 that tied the 88342 code to Lynch Syndrome tumor testing, thus requiring a prior authorization for any 88342 that comes through their door for processing. While the 88342 is indeed one code that could be used in Lynch Syndrome testing, it is certainly not exclusive to this.  Once these denials were detected, we promptly connected with a representative from MMO to review some of our claims, inclusive of pathology reports, so that they could see how these 88342 codes were being utilized. Roughly a month later, they rescinded the policy.  However, in order to get any claims paid, we needed to submit a “claims project” (fancy lingo for a spreadsheet with vital claim information) for MMO to reprocess the claims they originally denied.  We were informed by MMO that this would be the only way to ensure payment on these claims (Medical Mutual , 2014). Take-aways: 1). Pay close attention to your denials.  Is your biller providing you with detail of your denials monthly?  This is a great way to spot any denial trends. 2). Be sure your biller can trace back all claims that were denied AND provide reporting on payment for these claims to ensure the process has been complete. References Medical Mutual (2014, June ). Retrieved July 2014, from Medcal Mutual Medical Policies:...

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