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Thanks for investing in me (Employee letter)

Posted by on Jun 22, 2016 in Latest News | Comments Off on Thanks for investing in me (Employee letter)

At Vachette Pathology and Stark Medical Auditing and Consulting, we believe it’s important to not only invest in our clients, but to invest in our personnel as well. That’s why we enroll each of our new team members in Leadership Management International’s Effective Personal Producivity program. The course not only helps increase productivity by teaching how to set and achieve clear goals for each day, but also helps employees become better overall communicators and team players. Below is a letter written by Cody Raich, executive data analyst for Vachette and Stark, after he recently completed the EPP course. Cody is the son of Mick Raich, founder and president of Vachette and Stark. Michelle Miller and Dad, In December, I started working at Vachette Pathology as a non-intern for the first time.  My ‘other’ Vachette duties have been trash man, landscaper, and cleaning crew. I always envisioned myself working at Vachette for a large part of my upbringing.  Seeing my dad attend tradeshows in his fancy suits and shiny shoes always made me envious and also proud.  (Then I grew up. Just kidding). I never really understood what Vachette actually did for a long time.  I never understood the world of medicine.  The HCFA’s, the co-pay’s, all of it, seemed so foreign to me.  Over the past few months, I’ve really started to hone in on the services that Vachette provides.  I’ve been able to see with my own eyes the kinds of value that we provide our clients.  We’re simply there for them.  They have a problem and before anyone, Vachette comes running. Back to me.  Starting out, I really wanted to get in on the services. I really wanted to be able to help our clients.  Basically, like every team, I want to be a starter, not a benchwarmer.  In order to start, I had to hone my skills. I hadn’t been on Excel before December for years.  The idea of me in a cubicle to myself sounded like an early introduction to my coffin.  I had grand plans of travel and exploration.  I wasn’t heading towards exploration, I wasn’t heading towards travel, I was heading towards a disaster.  So I got out. My dad has been saying for years that if I ever needed to get out, reset, and try anew, that I should contact him.  I reluctantly did that.  I’m crass to a fault, risky to a fault, stubborn to a fault, and certainly proud to a fault (I wonder where I got that from).  All those things are nice, but they don’t grow you up. Sometimes you have to put away pieces of yourself, and try to conjure up different things I know I have deep down, but was too afraid to retrieve. Things like hard work, dedication, loyalty, character.  Basically all the things that any young adult shouldn’t avoid but does out of fear. I have always been incredibly scared of starting my ‘career.’  I am afraid that if I attempt greatness and fall up short that I’ll never be able to be happy with myself as a failure of greatness.  I never wanted to be a champion of good; I wanted to be a conqueror of the extraordinary. Enrolling me in EPP meant a lot.  It means a lot to be invested in. ...

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Is your outdated fee schedule leaving money on the table?

Posted by on Jun 17, 2016 in Latest News | Comments Off on Is your outdated fee schedule leaving money on the table?

Problem: We recently conducted a billing audit for a hospital-based physician group that purchases the technical component from its hospital when performing outreach work. However, a review of the group’s charges for TC work showed the rates they were contractually obligated to pay back to the hospital (which was the basis for their fee schedule) were significantly lower than what Medicare allowed almost across the board. When totaled, the difference between the charged and the Medicare allowed amounts for these codes accounted for a $57,000 loss of revenue in 2015, money that would have otherwise gone in the physicians’ pockets. Process: Since the group isn’t in an anti-markup state, we were able to quickly bump their TC fee schedule up to 100 percent of Medicare’s allowable rate. But, because their rates were so much lower than Medicare’s — 22 percent or less in multiple instances — it’s possible the hospital was nearly receiving less than cost for the use of its equipment. So why wasn’t the fee schedule updated sooner? In this instance, it essentially comes down to a matter of complacency. The group had had always reimbursed its full TC payments to the hospital, which in turn hadn’t updated its fee schedule for quite some time. While the hospital will now undoubtedly want to raise its reimbursement rate in future contracts, the group will be able to pocket the difference between the two rates in the meantime. This serves as a perfect example of why it’s important to regularly compare your fee schedule against Medicare’s to ensure it is up to date and helping you to maximize your revenue. Have questions or concerns about your fee schedule? Click here to request a free review...

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AACC honors Vachette President Mick Raich with 2015 Outstanding Speaker Award

Posted by on Jun 9, 2016 in Latest News | Comments Off on AACC honors Vachette President Mick Raich with 2015 Outstanding Speaker Award

Vachette Pathology is pleased to announce our president Mick Raich has been awarded the American Association for Clinical Chemistry’s 2015 Outstanding Speaker Award. The award recognizes speakers who earned an evaluation rating of 4.5 or higher during a 2015 continuing education activity accredited by AACC. Raich, who received the award for his speech forecasting 2016 financial and clinical strategies for pathology practices, said he was honored to be selected as one of the recipients of the AACC award. “I’m honored and humbled to be presented with this award,” Raich said. “It truly is a testament to my years of hard work in the health care industry and it only further inspires me to continue my efforts as an educator and innovator in the field moving forward.” Raich has spent his entire 32-year career in health care. His experience began in direct patient care, bereavement counseling, and hospital management and progressed into pathology billing sales and management, pathology practice sales and marketing, revenue cycle management, and strategic consulting. Since founding Vachette in 2001, Raich has grown the company into a nationwide consulting and management firm that specializes in working with independent labs, hospital-based pathology practices, hospital and health systems, and university pathology groups. In 2013, Raich founded Stark Medical Auditing and Consulting to offer his services to specialties outside of pathology. Click here to view a full list of recipients of the AACC’s 2015 Outstanding Speaker...

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Theranos: The company transparency forgot

Posted by on Jun 2, 2016 in Latest News | Comments Off on Theranos: The company transparency forgot

Theranos: The company transparency forgot

By: Jacob Vugrinac, Director of Business Development Editor’s note: This article was originally published in late 2015, prior to official announcements that Theranos is being investigated by multiple federal agencies due to allegations that the company misled investors about the readiness and accuracy of its blood testing technology. Yesterday, Forbes re-estimated Theranos Founder Elizabeth Holmes’ net worth at $0 after having named her America’s richest self-made women last year with an estimated value of $4.5 billion. You won’t find Theranos in the dictionary.  And you won’t find it in a textbook on Mythology next to Dionysus and Zeus.  Where you will find it is on the front page of Forbes and Newsweek.  Theranos is actually not a word at all.  It is an amalgam of the two words that Elizabeth Holmes set out to revolutionize: therapy and diagnosis. As a 19-year-old sophomore at Stanford, Elizabeth Holmes decided that college was only holding her back.  Her work in the lab had produced what she believed to be a ground breaking technique in blood analysis.  She threw caution to the wind, dropped out of school and used money that her parents had saved for her education to found her very own company.  And so Theranos was born in the basement of her college home (In the basement of my college house we played beer pong and explored the fine line between a good time and alcohol poisoning.  We could have used Holmes’ help to know exactly where that line is.) Fast forward to the present day.  Holmes is the world’s youngest female billionaire and her once subterranean business is now a major player in Silicon Valley with an estimated worth of $9 billion.  You could say that dropping out was probably the right move.  Theranos is believed to be on the cutting edge of a paradigm shift in health care.  Theranos claims to be able to run hundreds of tests on a drop of blood far more quickly than could be done with whole vials and at a much cheaper price.  Theranos threatens to turn Pathology as we know it on its head. But we haven’t even touched on the most interesting part of this story.  Are you ready for this?  No one knows how they do it.  Only Colonel Sanders and his 11 herbs and spices are shrouded in more secrecy.  Theranos has attracted attention for both the ambition of its mission and the secrecy that veils its means of achieving it. Theranos has kept its billion dollar secret for ten years now due to a regulatory gray area.  Most labs perform their testing on equipment that they purchase from outside manufacturers.  Before these medical device companies are permitted to sell their equipment it must be approved by the FDA; this approval makes the validity and performance of the testing available to the public.  But Theranos makes their own equipment and because of this is not required to rely on the FDA for approval as long as they do not sell this equipment to any other labs.  Very clever Miss Holmes. Well surely there have been studies performed comparing the results of Theranos’ testing to the methodology currently used today?  When asked this question, Holmes brought up a study that she co-authored for Hematology Reports that showed a strong correlation between Theranos...

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Check your billing after a system upgrade!

Posted by on May 26, 2016 in Latest News | Comments Off on Check your billing after a system upgrade!

Check your billing after a system upgrade!

By: Angela Granlund, Executive Client Administrator We recently had a pathology group whose hospital upgraded its Laboratory Information System (LIS).  Initially, everything appeared to be working smoothly after the upgrade. However, while reviewing date of service procedure volumes a couple months later, I noticed that two of the CPT codes that the group normally performs had no volumes being shown as billed out. The group had not changed their testing capabilities, so I contacted their billing agency to find out why these two codes were not being billed. The billing company said they had not noticed the drop in volume or questioned it. After researching the issue, the biller found that the codes were no longer coming through the feed from the hospital. Upon further investigation with the hospital, they learned that when the hospital updated to the new version of the LIS, a glitch caused these two codes from the feed to the billing company. If this error had not been caught, it would have cost the group about $13,000 in revenue. But once the omission was identified, the hospital fixed the issue, created a file of the missing codes reaching back to the date of the LIS update and sent it over to the billing company, who then filed the claims.  Fortunately, the issue was identified soon enough that no denials for timely filing occurred. What do you need to do to make sure this doesn’t happen to you? Make sure you are in the loop when it comes to hospital or laboratory system updates or upgrades. Alert the billing staff or company when you know system changes are scheduled. Require your billing staff or company to track procedural volumes every month as well as review the data and question any variances. Do you get regular feedback from your biller? Are you confident that they haven’t missed billing anything for you?  If not, give us a call at 517-486-4262 – we can help you find...

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Biller’s fee schedule oversight a costly one for Southern pathology lab

Posted by on May 19, 2016 in Latest News | Comments Off on Biller’s fee schedule oversight a costly one for Southern pathology lab

Biller’s fee schedule oversight a costly one for Southern pathology lab

Problem: A quarterly audit for an independent Southern pathology lab unveiled the lab received $31.94 less for its global 88305 CPT codes (a microscopic tissue examination to provide diagnosis) than its contracted rate with a large commercial insurance carrier allowed on about 50 percent of the codes reviewed. When contacted about the discrepancy, both the lab’s third-party biller and the carrier said they were unaware of the problem and were unsure as to why it was occurring. Since this particular carrier accounts for roughly 38 percent of the lab’s payer mix, the auditor determined the client could have lost up to $82,000 in 2015 if 50 percent of the lab’s total 88305 volume was underpaid as the audit showed. Process: To confirm the error, our auditor went as far as to locate two different cases that were billed identically (even down to the pre-fix) except for the patient ID numbers. Both were paid different rates, solidifying that there was no discernible reason for the difference. We’re also working to determine how the biller initially followed up on this case since the audit shows they received payment from the insurance carrier for a batch of 88305s and their system automatically accepted the adjustment on the same day. On its face, it looks like the biller was simply accepting what the carrier was paying without question. We are now following up to see if there is any possibility to appeal to reclaim these underpayments. Recommendations: Follow up with your biller the moment you feel revenue isn’t adding up: In this instance, our client said he felt like he was losing $10,000 a month despite doing more work. His gut feeling was correct. Know the appeal limit in your contracts: Sadly, some contracts with carriers stipulate providers have only 180 days to appeal for an underpayment. After that, any money owed to the provider is lost. Performing a regular quarterly audit will help ensure underpayments are identified in time for an appeal to be made. Most importantly: Your billing staff or company MUST actually compare the paid EOB to the amount you are allowed to collect. This can be difficult since many billers have a “managed care tracking module” in their software that is often rendered useless due to constant fee schedule changes. This comparison takes time and money, but in the end, the client makes more money. Who’s watching your revenue like this? Is this happening to your practice and you simply are unaware? Questions about how we can help maximize your practice’s revenue stream? Contact Mick Raich, president of Vachette Pathology and Stark Medical Auditing, at mraich@vachettepathology.com or call us at...

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Trump and Clinton on health care: The status quo vs. an undefined vision

Posted by on May 12, 2016 in Latest News | Comments Off on Trump and Clinton on health care: The status quo vs. an undefined vision

Trump and Clinton on health care: The status quo vs. an undefined vision

By: Alex Mitchell, Director of Information and Content Here we go. With Donald Trump having secured the 2016 Republican Party Presidential nomination after his two remaining primary opponents, Texas Senator Ted Cruz and Ohio Governor John Kasich, suspended their campaigns on the heels of Trump’s dominating win in the Indiana Primary, Trump’s campaign has now switched its focus to preparing for his likely Democratic opponent in the general election, former Secretary of State Hillary Clinton. Clinton needs to secure only a modest number of delegates in the remaining state primaries to ensure the Democratic nomination and avoid a contested convention with Vermont Senator Bernie Sanders. In a past life, I worked as a political reporter for a daily news outlet in Michigan, so I’ve seen my fair share of divisive candidates and issues. I can’t say, however, that I’ve ever seen two candidates as polarizing or as widely despised by opponents as Trump and Clinton. Whether it’s Trump’s at times bombastic rhetoric and status as an outsider to the Republican establishment, or Clinton’s missteps with Benghazi or her private email server during her time as Secretary of State, it’s clear that neither candidate is immune to criticism. While the two differ greatly on a wide variety of issues, their positions on health care reform should be watched closely in the lead up to the November general election. Clinton had made it clear she considers the Affordable Care Act a success that should be expanded on – albeit with a number of adjustments. Trump, on the other hand, has stated he would repeal Obamacare, but only recently has offered concrete details as to what a potential replacement might look like. Trump: With Trump, voters aren’t being sold on a specific health care vision, but are instead being offered a promise of reform many Republicans have called for since 2010: repealing Obamacare. Make no bones about it, Trump has made abolishing the controversial law a focal point of his campaign, going so far as to state on his campaign website that “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.” Let’s take a look at the other areas of health care reform Trump mentioned in March when his team released a seven-point plan that attempted to give backbone to his health care vision. In the plan, Trump pledged to: Abolish the ACA mandate requiring individuals to purchase health care. Allow individuals to make tax-free contributions to health savings accounts that would accumulate indefinitely and could be passed on to heirs without penalty. Allow individuals to fully deduct health insurance premiums from their tax returns. Modify laws to allow the sale of health insurance across state lines in hopes that increased competition will drive down costs. Convert Medicaid into a block-grant program to allow states to manage Medicaid without federal oversight. Allow protections for those with pre-existing conditions to remain intact. Relax regulations to allow cheaper drugs from overseas to enter the American market and require “price transparency” from all health care providers. Financials: Trump’s plan to repeal and replace Obamacare is estimated to cost $330 billion over a 10 year period when including estimates of faster economic growth, according to Congressional Budget Office data analyzed by the nonpartisan Committee for a...

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How offshore billing services will impact your practice’s bottom line

Posted by on May 4, 2016 in Latest News | Comments Off on How offshore billing services will impact your practice’s bottom line

By Cody Raich, Executive Data Analyst During the past five years, we have seen many billing companies lower their cost for services.  When this trend is examined, it becomes apparent that the lower cost is available because these billing services are offshoring their services. As medical billing companies increasingly look to offshore their services, many health care providers are now weighing the potential savings of going with an offshore company against the familiarity offered by onshore billers. However, rather than forcing health care providers to choose a side, Vachette Pathology and Stark Medical Auditing & Consulting predict the move toward offshore billing will force onshore billers to lower their rates to remain competitive. I’m often asked, “How do these offshore companies compare?”  This is always an interesting question. I usually tell the client what really matters is not where your billing is done, but how much you actually make.  Now if you want to raise the American flag and tout patriotism while driving your 35 percent foreign car, watching your Korean TV and chatting on your Chinese iPhone I can respect that. But, the bottom line is what actually is going into your American wallet. With your wallet in mind, let’s take a look at an example. Group A is a hypothetical U.S.-based provider whose services totaled $14 million in annual charges for 2015.  Let’s say payments received for charges were $2.7 million and the provider’s charges for onshore billing cost 7 percent of their payments, or $189,000 per year.  Conversely, let’s say offshore billing costs merely 4 percent, or $108,000 per year. Offshore billing cost = 4 percent * ($2.7 million) = $108,000 per year. Onshore billing cost = 7 percent * ($2.7 million) = $189,000 per year. Onshore – Offshore = $81,000 in annual savings (all outside variables held constant). The obvious initial conclusion is that Group A will save $81,000 for the year if they do their billing offshore. As noted in the accompanying graph, if all variables remain constant over a ten-year period, the group would realize a savings of nearly $810,000 by switching to an offshore billing service. However, for a group as large as this, a mere half a percentage point drop in collections will lose a surprising chunk of change ($70,000). In some situations a change in billers can lead to a 2 to 5 percent increase in collections after a switch. Collection % = $2.7 million / $14 million (Percent of charges that were actually collected in payments) For example, 2.7 / 14 = .192 or 19.2% But what if the biller increases the collection percentage?  Based on our projections, that could equal huge gains ($140,000 for every 1 percent increase in collections plus the initial $81,000 would equal a potential of $221,000 more for that year alone). This is the “double whammy” possibility that offshoring your billing presents. Taking this chance and receiving this result could be atypical, but not completely outside the realm of possibility.  If the right dominos fall, doctors and their practices could have a financial bump without additional charges. So why aren’t more practices utilizing this opportunity for savings?  The fact is, many billing services are moving offshore. Sure, they’ll still maintain an office in the U.S., but the actual billing is being done elsewhere.  Still,...

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Vachette Pathology President Mick Raich featured in Part B News!

Posted by on Apr 27, 2016 in Latest News | Comments Off on Vachette Pathology President Mick Raich featured in Part B News!

Trying to decide if an underperforming insurance plan is doing your practice more harm than good? Check out the April 18 issue of Part B News for input from Mick Raich, President of Vachette Pathology & Stark Medical Auditing and Consulting, and other experts who offer up five ways to help determine the overall worth of a plan before cutting ties with it.   Click here to view the article online. (Note: reading the full article requires a subscription to Part B...

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A quality conundrum: How changing CMS reimbursement rates affect patient care

Posted by on Apr 25, 2016 in Latest News | Comments Off on A quality conundrum: How changing CMS reimbursement rates affect patient care

By Jake Vugrinac, Director of Business Development We all read different things for different reasons.  Whether for business or pleasure, our taste in literature is diverse and unique.   Some of us enjoy immersing ourselves in the adventures of boy wizards, the love life of vampires or the impending doom that zombies pose to civilization.  I am not one of those people; I am a numbers guy.  I prefer curling up next to the fire with a riveting essay on sabermetrics in baseball.  And I realize I am in the minority here.  Most “normal” people don’t experience the warm embrace of contentment that can only come from your credits matching your debits.  I feel for people who will live a life devoid of the joy that only regression analysis and data sets can bring.  But today, I will try to bridge the gap between “numbers” people and “normal” people.  Regardless of your reading preferences, we all need to know the consequences that changing reimbursement rates have on health care. 2012 study of nationwide hospital reimbursement data shows higher Medicare reimbursement rates led to an increase in length of care for enrollees. CMS needs to take a good look at their payment structure and reevaluate how it calculates reimbursement rates to eliminate the discrepancy in length of stay between hospitals. Reimbursement changes will continue to send shock waves through hospitals and physicians nationwide and those in the position to make these changes need to be cognizant of that. I recently read a thesis, “Medicare’s Prospective Payment System: Do Differences in the Reimbursement Rate Affect Quantity of Care Delivered and Hospital Billing Practices?”, by Russell Hollis, a graduate of Duke University’s economics program.  This thesis investigated the correlation between changes to reimbursement rates and the quantity of health care received by length of stay.  The scope of this research included 470,000 patients in 2,696 hospitals in 2012.  In order to eliminate variables that could skew the results, the scope was limited to major replacement or reattachment of the lower extremity, DRG 470 (no complications) and DRG 469 (with complications) (Hollis, 2). The question posed is an important one: What effects do changing reimbursement rates have on patient care?  Changes in reimbursement rates are an unavoidable variable.  CMS is running out of money.  Because of this, they are changing the way they pay for hospital care.   By rewarding hospitals for delivering services of higher quality and higher value, they intend to drive down costs.  But to what degree will changes in CMS compensation to hospitals affect the treatment of the Medicare enrollees?  To find this answer, we will have to research how the treatment of patients differs by various hospitals receiving different compensation in Medicare reimbursement for the same diagnosis.  Finding the analytical answer to this question is where it gets a little…dry.  For the convenience and dwindling attention span of my audience, I will skip to the results and leave you to explore the delicate whimsy of regression analysis on your own time. The study found that a 1 percent increase in reimbursement led to a .007 percent (James Bond’s favorite percentage) increase in the length of stay for DRG 470 and a .057 percent increase for DRG 469 (Hollis, 33).  This data shows that even though the correlation may seem small,...

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