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20 November 2020: HHS Reverts Reporting Requirements for Provider Relief Fund, by AdvantEdge Healthcare Solutions
In September, HHS updated new reporting requirements for the Provider Relief Fund that raised concern throughout the healthcare industry. After multiple discussions with the provider community and congress HHS is now amending the guidance change to eliminate the risk of letting any of the $175 billion in PRF go unused. Even though HHS is taking a step back on the requirements created in September, it is not a complete reversal. Rest of article

10 November 2020: Tweetorial Tuesday, by Roche Diagnostics USA
Check out Tweets on VENTANA pan-TRK (EPR17341) Assay by #RocheDiagnosticsUSA at #NTRK on their #TweetorialTuesday. Click the link to check out the tweets with images of cases stained with pan-TRK IHC and multiple-choice questions! Follow @RocheDiaUSA on twitter. Rest of article

6 November 2020: CMS Expands Accelerated and Advance Payment (AAP) Program, by AdvantEdge Healthcare Solutions
The Centers for Medicare & Medicaid (CMS) announced it would alter the Accelerated and Advance Payment (AAP) program's repayment terms. The new repayment updates are as follows: Delay disbursement recoupments to one year from the date the payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. Rest of article

23 October 2020: Down the Ocular, by Roche Diagnostics Medical and Scientific Affairs Team
Listen to Drs. Bharathi Vennapusa and Tabari Baker from Roche Diagnostics MSA discuss various topics related to NTRK gene fusion testing on Down the Ocular podcast series including methodologies and recommendations for identifying patients with IHC testing prior to NGS confirmation. Click here to listen and don't forget to subscribe to Down the Ocular podcast series!

13 October 2020: Provider Relief Fund Report Requirements Update, by AdvantEdge Healthcare Solutions
The U.S. Department of Health and Human Services (HHS) released additional information outlining reporting requirements for health care providers who received and accepted funding exceeding $10,000 from the Provider Relief Fund. The essential guidelines are summarized in this article: Rest of article

27 August 2020: Proposed Rule - 2021 Medicare Physician Fee Schedule, by AdvantEdge Healthcare Solutions
On August 3rd, the Centers for Medicare and Medicaid Services (CMS) published the 2021 Medicare Physician Fee Schedule, which includes CMS only allowing a comment period of 30 days for the draft (instead of the normal 60 day period). Rest of article

30 July 2020: FAQs Medicare fee-for-service billing, by AdvantEdge Healthcare Solutions
CMS released an updated COVID-19 FAQ on Medicare fee-for-service billing for COVID-19 related services. The policies in the article are effective for the duration of the PHE unless superseded by future legislation. With 41 sections and over 200 questions and answers, we highlighted key information. Rest of article

20 July 2020: Pathology Billing Tipsheet: 4 Ways to Reduce Billing Errors and Increase Revenue (PDF), by AdvantEdge Healthcare Solutions
Pathology billing and coding have complex regulations and rules, and there are many steps involved. Mistakes can occur at many points in "front-end" and "back-end" processes and can reduce collections by five percent or more, costing a typical practice or department hundreds of thousands of dollars, and frequently more. Mistakes also increase days in A/R, delay reimbursement and lead to compliance violations or fines. Rest of article

9 June 2020: 7 Ways to Help Create a Sustainable Competitive Advantage, by Change Healthcare
Today's healthcare providers are facing increasing revenue pressure from declining reimbursement, fixed costs, and growing patient responsibility. Labs are no exception. Maintaining existing business while growing new referral sources is essential to long-term viability. It is also important for supporting investments into new technology and systems that will help labs stay competitive. And competition is increasingly a factor as lab groups nationwide are targeting one another's clients as part of their own growth strategies. Rest of article

20 May 2020: How Business Intelligence Delivers Financial Insight to Outreach Labs, by Change Healthcare
Hospital-based 'outreach' laboratories are under increasing financial pressure due to escalating costs, falling reimbursements, and growing competition. As a result, there's little margin for error when it comes to financial management.Enter business intelligence (BI) tools, which can help analyze the past,interpret the present, and forecast the future, including identifying and addressing vulnerabilities before profitability is affected. Rest of article

1 April 2020: UnitedHealthcare Requiring Hospital Outreach Labs to Contract as Independent Reference Labs, by AdvantEdge Healthcare Solutions
Effective May 1, 2020, UnitedHealthcare (UHC) will deny any non-patient lab test claims submitted by hospital outreach labs if billed under the hospital’s facility participation agreement. Rest of article

25 March 2020: Revenue Cycle Management Services Help Stamford Pathology Group, PC Restore Reimbursement Cuts, by Change Healthcare
Like many clinical laboratories, Stamford Pathology Group, PC (SPG) has worked hard in recent years to overcome rising costs, falling reimbursements, and volume declines triggered by medical practices taking their laboratory work in-house. Fortunately, the group hasn’t had to battle this alone. Since 2006, SPG has partnered with a leading revenue cycle and practice management vendor. Together, an action plan was created to increase revenue, reduce costs, and improve coding accuracy. Rest of article

18 March 2020: Outsourced Billing can Give Pathology Practices a Boost, by Change Healthcare
Amid the turmoil and uncertainty of healthcare today, it's understandable that some pathology groups are reluctant to consider shifting from internal billing operations to an outsourced revenue cycle management vendor. But as regulations become more complex and the pressure mounts from declining reimbursements, the importance of optimizing the revenue cycle cannot be overstated. Despite the best efforts of many internal departments, healthcare’s structural changes increasingly demand a more efficient, effective and resource-rich approach. Rest of article

11 March 2020: 10 Ways To Grow Your Pathology Practice in 2020, by Change Healthcare
In today's dynamic healthcare environment, pathologists are looking for every strategy to grow revenue and reduce costs, all while improving the overall patient experience. There is a heavy emphasis on making data-driven decisions, giving practices the boost they need to make better strategic moves when it comes to growth planning. Here are 10 ways to grow revenue at your pathology practice in 2020. Rest of article

2 March 2020: CMS Develops New Code for Coronavirus Lab Test, by AdvantEdge Healthcare Solutions
On February 13, CMS introduced a new code that enables laboratories conducting Coronavirus tests to bill for the specific test instead of using an unspecified code. Specifically, the agency developed a new HCPCS code for providers and labs to test patients for SARS-CoV-2. According to the announcement, this code will allow labs conducting 2019-Novel Coronavirus (COVID-19) tests to bill for the specific test instead of using an unspecified code. Rest of article

16 January 2020: Clinical Laboratory Data Reporting Delayed, by AdvantEdge Healthcare Solutions
CMS issued a notice stating that Clinical Diagnostic Laboratory Tests (CDLTs) that are not Advanced Diagnostic Laboratory Tests (ADLTs), private payor data reporting will be delayed by one year. Rest of article

2 January 2020: CMS has Published the Physician Fee Schedule for 2020. The Time to Get Ready is Now, by David Nicholson, AdvantEdge Healthcare Solutions
CMS has issued its final rule for the 2020 Medicare physician fee schedule, effective January 1. With the added complexity to billing and coding for physicians, how you manage the revenue cycle process for the practice is more important than ever. For your convenience, I have summarized the major changes and provided links to additional resources available from CMS for more detailed explanations. Rest of article

4 December 2019: RTI International and U.S. Department of Health and Human Services, Answering the Medical Expenditure Panel Survey, by Jeanne A. Gilreath, AdvantEdge Healthcare Solutions
What is my obligation to provide information to RTI, who calls our office stating that (s)he is “calling on behalf of the U.S. Department of Health and Human Services (HHS) for Medical Expenditure Panel Survey (MEPS)?” Rest of article

20 November 2019: 2021 Proposed Changes for Evaluation and Management Services, by Marie Franklin, AdvantEdge Healthcare Solutions
The proposed new rules for 2021 will focus on medical decision-making or time as the determining factor when selecting the appropriate level for service rendered for all physicians for evaluation and management. Rest of article

11 November 2019: What You Should Consider When Contemplating Going Out-of-Network, by Rob Saunders, Change Healthcare
In an ideal world, physician practices would reach equitable terms in every payer negotiation and there would be no need to consider going out-of-network. But in today’s marketplace, incompatible organizational goals sometimes leave practices with no choice but to walk away from payer networks. Rest of article

11 October 2019: The Healthcare Landscape is Changing – Billing Services are the Safe Bet, by Brice Voithofer, Senior Vice President, AdvantEdge Healthcare Solutions
Through continuous process improvement (CPI) successful companies constantly re-evaluate their business process to assure they are running their business in the most effective, efficient and innovative manner. Medical practices are no different and must adapt to the ever-changing landscape to survive long-term. Companies that thrive are the ones that create the correct environment for success. Rest of article

19 September 2019: Customer Service Should be an AdvantEdge in Your Practice, by Michael J Krivich, AdvantEdge Healthcare Solutions
We all know the importance of customer service as it relates to patient experience and satisfaction with physician services in today’s healthcare environment. Patients rank their satisfaction with the physician services in surveys by the practice, in the CMS Fee-For-Service CHAPS survey, and by other private survey companies like J.D. Powers, for example. Rest of article

5 September 2019: CMS Targeted Probe and Educate Audit Program, by Jeanne A. Gilreath, AdvantEdge Healthcare Solutions
One of the many programs CMS has implemented to help providers identify billing issues is the Targ eted Probe and Educate (TPE) audit program. It is designed to identify providers with high denial rates or unusual billing practices according to CMS. Rest of article

12 August 2019: MIPS for Pathologists: Proposed changes for 2020, by Mick Raich, Vachette Pathology
Just as participants of the Merit-based Incentive Payment System were becoming comfortable with the programs requirements and the steps necessary to avoid penalties to their Medicare Part B payments, CMS has indicated it intends to again ramp up reporting requirements for the 2020 performance year, according to the 2020 Medicare Physician Fee Schedule Proposed Rule published July 29. Rest of article

12 August 2019: Laboratory Economics Survey Highlights Increase in Industry Concern around Pathology Reimbursement, by Steve MacCrea, AdvantEdge Healthcare Solutions
A recent study by Laboratory Economics (LE) - an independent research and analysis firm focusing on pathology and the laboratory services industry - shows that 82.4% of labs and pathologists cite declining reimbursement as one of the industry’s biggest challenges. Rest of article

5 August 2019: Surprise Billing Legislation is Gaining Traction with an Unknown Future for Physicians, by David Nicholson, AdvantEdge Healthcare Solutions
Surprise medical bills occur when an insured patient unintentionally receives care from an out-of-network provider. And, according to a 2018 survey conducted by the University of Chicago, more than half of Americans (57%) have received at least one unexpected medical bill that they believed was covered by insurance. Rest of article

1 August 2019: Pathology Services See Neutral Overall Adjustment in Proposed 2020 MPFS, by Mick Raich, Vachette Pathology
After a significant delay, CMS released its Proposed 2020 Medicare Physician Fee Schedule Monday evening. Its release marked the longest delay in the rule's annual release since 2006, when it was held from public view until August of that year. Rest of article

26 June 2019: Change Healthcare Helps Meridian Laboratory Physicians Navigate Difficult Waters, by Change Healthcare
How can Change Healthcare help laboratories improve billing operations and revenue? Read our case study to see how we helped Meridian Laboratory Rest of article

12 June 2019: Vachette examines Anthem pathology cuts in 'Laboratory Economics', by Mick Raich, Vachette Pathology
As Vachette continues to lead the charge against Anthem's misguided rate adjustments for pathology and lab services in several states throughout the country, we're fielding more questions about what options labs facing these cuts truly have. Recently, Vachette CEO Mick Raich and VP of Client Services Ann Lambrix, spoke with Laboratory Economics Publisher Jondavid Klipp to examine the potential scope and overall impact of these cuts. Rest of article

12 June 2019: 3 Common ASC Billing Mistakes, by AdvantEdge Healthcare Solutions
These common mistakes, originally published in Becker's ASC Review, provide areas to evaluate to improve your surgery center's coding and billing results. Rest of article

16 May 2019: 3 Tips to Improve Your Billing (PDF), by AdvantEdge Healthcare Solutions
Every practice knows that billing and collecting gets harder every day. Insurance companies change their rules and parameters, patients owe a larger proportion due to co-pays and high deductible health plans, and there are more audits than ever before. Rest of article

8 May 2019: NILA Seeking Public Feedback on PAMA Cuts Impact, by Mick Raich, Vachette Pathology
Laboratories and pathology groups who have been feeling the crunch created by reimbursement cuts under the Protecting Access to Medicare Act (PAMA) are being asked to sound off in a public survey being conducted by the National Independent Laboratory Association. Rest of article

2 May 2019: New Molecular LCDs to Take Effect Next Month, by Mick Raich, Vachette Pathology

15 April 2019: In-House Billing or a Billing Service (PDF), by AdvantEdge Healthcare Solutions

15 April 2019: Michigan BCCCNP Rates Receive Another Bump, by Mick Raich, Vachette Pathology

15 April 2019: Missed Appeals, Bad Write-Offs and More From Our Latest Audit Roundup, by Mick Raich, Vachette Pathology

15 April 2019: MIPS Payment Adjustments Not Appearing as Expected on 2019 EOBS, by Mick Raich, Vachette Pathology

5 April 2019: Looking ahead to the Executive War College on Laboratory and Pathology Management, by Mick Raich, Vachette Pathology

13 March 2019: Medi-Cal Now Seeking 2018 Private Payer Data, by Mick Raich, Vachette Pathology

13 March 2019: How to Evaluate a Billing Company (PDF), by AdvantEdge Healthcare Solutions

6 March 2019: Understanding Your Clinical Lab’s Liability Under EKRA, by Mick Raich, Vachette Pathology

27 February 2019: Is Your Lab Following New FNA Coding Guidelines?, by Mick Raich, Vachette Pathology

13 February 2019: New Policy from Anthem of MO Heavily Impacts Lab Payments, by Mick Raich, Vachette Pathology

21 January 2019: CMS Laboratory Date Of Service Exception Policy Update, by AdvantEdge Healthcare Solutions

21 January 2019: Reminder: Include Interpretation Location On Lab Reports To Avoid Citations, by Mick Raich, Vachette Pathology

19 December 2018: Sonic Healthcare Set to Purchase Aurora Diagnostics for $540 Million, by Mick Raich, Vachette Pathology

18 December 2018: Report: UHC Terminating Contracts Of Some Regional, Independent Labs, by Mick Raich, Vachette Pathology

4 December 2018: CMS Implements Overall Cuts For Pathology, Independent Lab Services In 2019 MPFS Finale Rule, by Mick Raich, Vachette Pathology

3 December 2018: MIPS 2019 Final Rule: What Pathologists Need To Know, by Mick Raich, Vachette Pathology

30 October 2018: Update: Prior-Authorization Continues to Cause Confusion (and Missed Payments), by Mick Raich, Vachette Pathology

8 October 2018: Compliance Issues, MUE Denials and More in Vachette’s 2018 Audit Roundup, by Mick Raich, Vachette Pathology

30 July 2018: MIPS 2019 Proposed Rule: What Pathologists Should Watch For, by Mick Raich, Vachette Pathology

17 July 2018: Independent Labs Eye Boon as CMS Proposes to Increase TC Rates for Key Pathology Services, by Mick Raich, Vachette Pathology

26 June 2018: Payment Cuts for Pathology, Radiology Proposed by MedPAC, by Mick Raich, Vachette Pathology

7 June 2018: Carrier’s Confusion Over Third-Party Policy Causes Improper Denials, by Mick Raich, Vachette Pathology

21 May 2018: Maximizing Revenue Under the BCBSM Incentive Program, by Mick Raich, Vachette Pathology

24 April 2018: Check Your 2018 MIPS Participation Status, by Mick Raich, Vachette Pathology

4 April 2018: Current Metrics in Medical Billing Contracts - White Paper, by Mick Raich, Vachette Pathology

14 March 2018: Analyzing the Overhauled 14-Day Molecular Billing Rule, by Mick Raich, Vachette Pathology

21 February 2018: Pivotal Health Offers Clinical Labs Tools to Succeed in Evolving Value-Based Market, by Mick Raich, Vachette Pathology

8 February 2018: Navigating the CMS "Targeted Probe and Educate" Audit Initiative, by Mick Raich, Vachette Pathology

24 January 2018: How MIPS Will Affect Pathologists in 2018, by Mick Raich, Vachette Pathology

15 December 2017: Vachette Supports Dr. James E. Richard for 2019 CAP Presidential Bid, by Mick Raich, Vachette Pathology

28 November 2017: What Could a Single-Payer Plan Mean for Pathologists?, by Mick Raich, Vachette Pathology, categories: billing

13 November 2017: Prostate Biopsy, Flow Cytometry Cuts Finalized in 2018 Medicare Physician Fee Schedule, by Mick Raich, Vachette Pathology, categories: billing

23 October 2017: Deadline Approaching to Request PQRS Informal Review!, by Mick Raich, Vachette Pathology, categories: billing

4 October 2017: PAMA Proposed to Have Heavy Impact on 2018 Clinical Lab Tests, by Mick Raich, Vachette Pathology, categories: billing

20 September 2017: Time is Running Out for MIPS Improvement Activities!, by Mick Raich, Vachette Pathology, categories: billing

6 September 2017: Avoiding Scrutiny Under the New CMS Audit Process, by Mick Raich, Vachette Pathology, categories: billing

9 August 2017: Lab Prior-Authorization Programs Continuing to Evolve, by Mick Raich, Vachette Pathology, categories: billing

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