Latest News

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

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

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

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

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

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, 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

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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Large Commercial Payer Under Pays for Prostate Biopsy Code G0416

Posted by on Feb 12, 2015 in Latest News | Comments Off

Better look closely at your billing.  Why?  We found a large commercial payer which is not paying according to contract. Why would this matter if you are a professional provider billing under the CMS physician fee schedule?  Well, take a look at the prostate biopsy code G0416.  Per the carrier contract, the G0416 is to be paid at 125% of the insurance fee schedule; however, the carrier has been recognizing this G0416 under the contracted amount for “all other HCPCS codes,” which represents 70% of Medicare. Is this costing you money?  How are...

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How has the Affordable Care Act impacted your payments?

Posted by on Jan 31, 2015 in Latest News | Comments Off

Does it seem you worked harder for less money in 2014?  The answer may be found by reviewing claims submitted to new healthcare plans created by the Affordable Care Act. We did just that and found some very interesting shifts. During the last part of 2014, some of our clients had fewer charge dollars going to traditional Medicaid, moving instead into new managed medical assistance and exchange plans.  With this change, we have seen the collection percentage (payments divided by charges) decline compared to what traditional Medicaid had been...

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The Path Forward for Pathologists and AP Labs: Developing a Business Plan for the Next Five Years

Posted by on Jan 28, 2015 in Latest News | Comments Off

Mick will be presenting at the upcoming G2 PathForward Symposium March 14, 2015: The Path Forward for Pathologists and AP Labs: Developing a Business Plan for the Next Five Years What does the future bode for pathology groups and independent labs from a revenue point of view? As revenues continue to decline, it is imperative that your group or lab have a strategy going forward. This plan should include how to deal with new proposed mergers or relationships, managed care and ACO proposals, and revenue changes from both government and...

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PQRS Pay Cuts – Notification Letters Issued

Posted by on Dec 2, 2014 in Latest News | Comments Off

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...

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