Latest News

Have you seen a decrease in your Anthem payments? This may be why

Posted by on May 20, 2015 in Latest News | Comments Off on Have you seen a decrease in your Anthem payments? This may be why

If you are a provider in the following states, be aware: OH, KY, IN, MO, WI, CT, NH, ME, VA Anthem Blue Cross and Blue Shield began migrating their Medicare Advantage members to a new claims processing system starting in January of 2015. Providers, this new processing system could impact your claims receipt.  Claims are validated as received through the clearinghouse, but Anthem is unable to identify claims submission via their online portal or through customer service. If you have seen a recent spike in your Anthem accounts receivable, and a...

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Billing Transition Issues Concerning Old Receivables

Posted by on May 4, 2015 in Latest News | Comments Off on Billing Transition Issues Concerning Old Receivables

Every year we assist 15 to 20 clients as they transition from one billing firm to another.  The reasons for these transitions are varied; usually it boils down to a lack of performance followed by a lack of communication, sometimes both. One of the big issues we see in these transitions is the handling of old receivables from the previous billing company.  Often the original biller works these claims for three months, then rolls them off to collections. But what next? You should ask yourself: What does your billing contract state regarding...

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Out-of-Network Labs, Pathologists May Have Some Recourse Against Insurers

Posted by on Apr 30, 2015 in Latest News | Comments Off on Out-of-Network Labs, Pathologists May Have Some Recourse Against Insurers

Out-of-network (OON) laboratories and pathologists who have been underpaid by insurers now may have some recourse. Two recent court rulings appear to clear the way for OON providers to sue insurers in federal court. As insurers increasingly narrow their networks, more and more providers find themselves on the outside looking in, fighting to receive appropriate payment for the services they provide. For years now, insurers have tried to limit payment to providers and discourage out-of-network utilization through higher patient deductibles and...

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The Impact of H.R. 2 on Your Practice & What You Need to Do

Posted by on Apr 28, 2015 in Latest News | Comments Off on The Impact of H.R. 2 on Your Practice & What You Need to Do

Since the Senate approved the H.R. 2 Medicare Access and CHIP Reauthorization Act of 2015 and averted a 21% pay cut, CMS announced an effort to minimize financial effects on providers: They would institute a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. On April 15, 2015, CMS announced that these held claims would begin processing with the negative rate update on a first-in, first-out basis as of April 15. Meanwhile, they will continue to hold new claims as they are received. The H.R....

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The Shifting Self-Pay Revenue Cycle and its Relationship to U-6 and U-3 Unemployment Rates

Posted by on Apr 1, 2015 in Latest News | Comments Off on The Shifting Self-Pay Revenue Cycle and its Relationship to U-6 and U-3 Unemployment Rates

By John Berry and Mick Raich Vachette Pathology Many practices, hospitals and health systems are searching for answers to collecting their self-pay dollars, and with good reason. There has been a huge shift in self-pay financials over the last seven years. Most of our clients have seen their self-pay collection percentages go from 15-20 percent to less than 10 percent. What is the cause behind this change, and why has self-pay not rebounded with the recent financial upturn touted by the government? Perhaps the economy, specifically the...

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The SGR ‘Fix’ and How It Affects Your Practice Revenue

Posted by on Mar 27, 2015 in Latest News | Comments Off on The SGR ‘Fix’ and How It Affects Your Practice Revenue

Recently H.R. 2 was passed in the House, the Medicare Access and CHIP Reauthorization Act of 2015.  This would permanently repeal the SGR formula and replace it with a formula that will give half of one percent increases for the next five years, and then move all physicians into the value-based payment program. The bill is now in the Senate.  The bill has to pass before April 1st to prevent a 21% pay cut from Medicare, and the Senate is scheduled to go on break today until April 13th. What this effectively means is physicians’ payments are...

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White Paper: Business Strategy for Pathology Practices and Independent Laboratories

Posted by on Mar 17, 2015 in Latest News | Comments Off on White Paper: Business Strategy for Pathology Practices and Independent Laboratories

Recently, I was asked to speak at the G2 PathForward Symposium about business strategies for pathology practices and independent laboratories, including issues such as mergers and acquisitions, the ACO movement, revenue, and managed care changes. My goal was to look at strategies over the next one to five years and offer some action steps that conference attendees could use to prepare for the future. For those who missed the symposium, I’ve collected the main points of my presentation in a new white paper, “Business Strategy for...

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Another Round of Payment Denials with IHCs, 88341 and the Prostate G Codes

Posted by on Mar 13, 2015 in Latest News | Comments Off on Another Round of Payment Denials with IHCs, 88341 and the Prostate G Codes

It seems our latest audit has caught a glitch in Medicare Immunohistochemistry (IHC) payments. We found that Cahaba GBA, which serves as the Medicare administrative contractor for Alabama, Georgia, and Tennessee, is denying claims for CPT code 88341 as multiples, using various denial codes: MA15 – Your claim has been separated to expedite handling M53 – Missing/incomplete/invalid days of units of service M59 – Missing/incomplete/invalid “to” dates of service MA130 – Your claim contains incomplete and/or invalid information, and no appeal...

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‘Requisites to Strategic Planning’ published in Archives of Pathology

Posted by on Mar 10, 2015 in Latest News | Comments Off on ‘Requisites to Strategic Planning’ published in Archives of Pathology

Vachette President Mick Raich was recently published in the Archives of Pathology & Laboratory Medicine as co-author of the article, “Requisites to Strategic Planning.” An excerpt appears below. Read the full article at archivesofpathology.org, or download the PDF » Until a few years ago, the business environment for the practice of pathology was robust: stable third-party reimbursement, high revenues, content customers, and negligible competition. However, that environment is changing and the future does not look so...

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Vachette Newsletter – Winter 2015

Posted by on Feb 25, 2015 in Latest News | Comments Off on Vachette Newsletter – Winter 2015

Our quarterly newsletter is out! To download this collection of our best articles and social media updates from the past few months, please join our mailing list. We promise not to share your email or send you spam, and you can unsubscribe at any time. You’ll be one of the first to know when we publish the next Vachette Pathology newsletter. First Name (required) Last Name (required) Your Email...

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