Management of Pathology Practices

Revised: 5 December 2016, (c) 2004-2016, PathologyOutlines.com, Inc.
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Related chapters: Computer Systems, Laboratory Administration
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The articles below have been written or adapted exclusively for PathologyOutlines.com. They reflect the views of the authors, and not necessarily those of PathologyOutlines.com. Contributors have paid a fee to appear on this page. The Management chapter below is a compilation of information from various sources, including those listed under Primary References.


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Recently Posted Articles
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Navigating MUEs by Mick Raich, Vachette Pathology, posted 29 November 2016
As with most CMS initiatives, it can be difficult to keep pace with the constantly evolving list of medically unlikely edits, especially when considering CMS and other carriers reserve the right to maintain a list of unpublished MUEs that providers and their billers likely won't know about until they receive a denial. We were first gifted with these edits when CMS implemented an unpublished MUE list in 2007 with hopes of reducing the error rate of paid claims. Fortunately, the agency decided to begin publicly publishing most MUEs in October 2008, and now updates the list quarterly. Rest of article

Best Practices For Approaching Payer Audits by Mick Raich, Vachette Pathology, posted 15 November 2016
As we continue to see an increasing number of payer audits in the pathology world, we wanted to take the time to walk you through some best practices and helpful tips for navigating these audits and protecting your revenue. It's important to note that these audits will not be limited strictly to Medicare. Many managed care organizations have identified this as potential cost savings and now have their own internal audit teams or have hired third party auditors to validate your charges. Sometimes, these requests may not be directly addressed as an audit and may instead come in another form. It is imperative that you or your biller are on the lookout for these types of communication (or denials). Rest of article

MACRA Final Rule Should Ease Providers' Fears For Now by Alex Mitchell, Vachette Pathology, posted 1 November 2016
At long last, the Medicare CHIP and Reauthorization Act (MACRA) Final Rule has been released upon us, and lo and behold, the sky has not fallen. Our initial analysis shows that all the hand-wringing and apocalyptic proclamations were a bit overstated given that we now know providers who are currently engaged in some form of quality reporting will be able to easily avoid penalties to their Medicare reimbursements for the foreseeable future without being burdened with new reporting requirements. Rest of article

Collection Agency's Blunder Leaves $565K In Limbo by Mick Raich, Vachette Pathology, posted 17 October 2016
A Midwestern pathology group we assist was recently being pushed by its third-party collection agency to pursue legal action for a number of unpaid accounts. Because of this discussion, we began receiving reports from the collection agency that were supposed to show the accounts the agency received each month from the group's biller. However, as soon as we saw the account volume in the report, we knew something was off. Rest of article

How Pathologists Can Survive MIPS In 2017 by Mick Raich, Vachette Pathology, posted 28 September 2016
Is your practice still scrambling to get a handle on the ins and outs of the Merit-Based Incentive Payment System before it goes into effect Jan. 1? Well, take solace in knowing you're not alone. In its current iteration, the proposed MIPS rule laid as part of the Medicare Access and CHIP Reauthorization Act (MACRA) was, simply put, not designed with pathology in mind. Rest of article

Several Pathology Codes Could See Significant Cuts Under Proposed Medicare Fee Schedule by Mick Raich, Vachette Pathology, posted 14 September 2016
The Centers for Medicare and Medicaid Services has proposed rate cuts for a large number of TC pathology codes in its proposal for the agency's 2017 Medicare Physician Fee Schedule, a move the agency has justified primarily as a reflection of the reduced cost of supplies for these procedures. The most significant proposed cuts would affect TC rates for 17 codes, with the most notable being a 15 percent reduction for 88305-TC ($29.34) that CMS has attributed to the decreased cost of utilizing eosin stain supplies rather than eosin solution. Rest of article


Coding Questions
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Thyroid FNA / 88172, 88177
Sentinel node biopsy / 88311, 88387-88388


Archive of All Articles
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Billing

Auditing your billing
Stories That Will Curl Your Hair Or Close To It!, by Michelle Miller, Vachette Pathology, posted 15 March 2011
The Basics of Auditing Your Pathology Billing (III), by Mick Raich, Vachette Pathology, posted 5May05
The Basics of Auditing Your Pathology Billing (II), by Mick Raich, Vachette Pathology, posted 5Jan05
The Basics of Auditing Your Pathology Billing (I), by Mick Raich, Vachette Pathology, posted 20Oct04

Billing-general
Navigating MUEs by Mick Raich, Vachette Pathology, posted 29 November 2016
Best Practices For Approaching Payer Audits by Mick Raich, Vachette Pathology, posted 15 November 2016
MACRA Final Rule Should Ease Providers' Fears For Now by Alex Mitchell, Vachette Pathology, posted 1 November 2016
Collection Agency's Blunder Leaves $565K In Limbo by Mick Raich, Vachette Pathology, posted 17 October 2016
How Pathologists Can Survive MIPS In 2017 by Mick Raich, Vachette Pathology, posted 28 September 2016
Several Pathology Codes Could See Significant Cuts Under Proposed Medicare Fee Schedule by Mick Raich, Vachette Pathology, posted 14 September 2016
PAMA Final Rule: What To Know And Who It Affects by Mick Raich, Vachette Pathology, posted 30 August 2016
A Quick Look At The 2017 Proposed Medicare Fee Schedule by Mick Raich, Vachette Pathology, posted 17 August 2016
Is Your Outdated Fee Schedule Leaving Money On The Table? by Mick Raich, Vachette Pathology, posted 3 August 2016
Revenue Changes For Health Care In 2016...So Far by Mick Raich, Vachette Pathology, posted 20 July 2016
Check Your Billing After A System Upgrade! by Angela Granlund, Vachette Pathology, posted 6 July 2016
Billers Fee Schedule Oversight A Costly One For Southern Pathology Lab by Mick Raich, Vachette Pathology, posted 20 June 2016
How Offshore Billing Services Will Impact Your Practice's Bottom Line by Cody Raich, Vachette Pathology, posted 25 May 2016
Preparing for the Merit-Based Incentive Payment System, by Alex Mitchell, Vachette Pathology, posted 11 May 2016
How CMS Plans to Save the Equivalent of Mongolia's GDP on Pathology, by Mick Raich, Vachette Pathology, posted 10 November 2015
Medicare Learning Network Update: New & Revised Codes for Outpatient Hospitals, by John Berry, Vachette Pathology, posted 27 October 2015
ICD-10 Is Here for Pathology, by Bill Gilbert, Vice President of Marketing, AdvantEdge Healthcare Solutions (AHS), posted 16 October 2015
The Wrath of the Titans Falls on Physicians and Consumers, by Jacob Vugrinac, Vachette Pathology, posted 13 October 2015
Good Old Rocky Top: Keeping its Physicians Independent, by Jacob Vugrinac, Vachette Pathology, posted 29 September 2015
An Overview of the New Proposed Medicare Fee Schedule, by Mick Raich, Vachette Pathology, posted 16 September 2015
Business Strategy for Pathology Practices and Independent Laboratories, by Mick Raich, Vachette Pathology, posted 3 August 2015
Billing Transition Issues Concerning Old Receivables, by Mick Raich, Vachette Pathology, posted 29 May 2015
Out-of-Network Labs, Pathologists May Have Some Recourse Against Insurers, by Mick Raich, Vachette Pathology, posted 15 May 2015
The Impact of H.R. 2 on Your Practice & What You Need to Do, by Mick Raich, Vachette Pathology, posted 1 May 2015
Business Strategy for Pathology Practices and Independent Laboratories, by Mick Raich, Vachette Pathology, posted 17 March 2015
New Business Model for Medical Billing Companies, by Mick Raich, Vachette Pathology, posted 22 October 2014
The Warning Signs of a Failing Billing Company or Revenue Cycle Management Firm, by Mick Raich, Vachette Pathology, posted 8 May 2014
Part A and Medical Directorship Contracts, by Mick Raich, Vachette Pathology, posted 28 April 2014
Sample Impact Analysis for the 88342 / G0461 changes by Mick Raich, Vachette Pathology, posted 8 January 2014
Ten Ways to Improve Your Requisitions, by Leigh Polk, McKesson Revenue Management Solutions, posted 11 October 2013
Thoughts on the Proposed Medicare Fee Schedule, by Mick Raich, Vachette Pathology, posted 2 August 2013
Commercial Insurance Plans following the Technical Component (TC) Grandfather Changes, by Mick Raich, Vachette Pathology, posted 21 May 2013
Could This Be the End of Insourced Pathology Billing? by Mick Raich, Vachette Pathology, posted 25 February 2013
A Managed Care Contracting Plan for Independent / Outreach Labs, Or How to stay profitable even if Medicare cuts your rates - Part One, by Mick Raich, Vachette Pathology, posted 15 January 2013
Locum Tenens - Applying it Correctly, by John R. Outlaw, CHC, CHBME, PSA, LLC, posted 12 December 2012
Changes in the Anatomic Pathology Billing World, by Mick Raich, President, Vachette Pathology, posted 14 November 2012
Missing Accession Audit Process, by Diana Brooks, PSA, LLC, posted 14 November 2012
Thoughts for the New Year (2012), by Mick Raich, Vachette Pathology, posted 26 January 2012
How to Gain a Better Managed Care Contract for your Independent Laboratory, by Mick Raich, Vachette Pathology, posted 9 September 2011
1993 Medicaid Reform Comes to Florida, by Mick Raich, Vachette Pathology, posted 1 April 2011
10 Questions to Ask Your Prospective Billing Company, by by Diana R. Brooks, PSA, posted 22 November 2010
Revenue as a By-Product of Investment: 6 Factors to Consider When Researching Billing Companies, by Diana R. Brooks, PSA, posted 12 November 2010
Changing Billing Services, by Mick Raich, Vachette Pathology, posted 28Aug10
Pathology Practices: Are Your Payers Paying You Correctly? Are You Sure? Can You Prove It?, by Al H. Sirmon and Stephanie Denham, PSA, posted 3Jun10
How to Utilize Your Billing Reports to Maintain and Grow Market Share. by Leigh Polk, PSA LLC, posted 24Apr10
Another Pay Cut for Pathology Practices and Laboratories, by Mick Raich, Vachette Pathology, posted 15Feb10
Payor Relationship Management Strategies and Trends: A Revenue Cycle Management Perspective, by Leigh Polk, PSA, LLC, posted 31Jan10
Underpayment of Pathology Technical Component, by Mick Raich, Vachette Pathology, posted 20Jan10
How the New Anti-Markup Rules May Change Your Practice, by Michelle Miller and Mick Raich, Vachette Pathology, posted 15May09
Billing Contracts verses Managed Care Contracts, by Mick Raich, Vachette Pathology, posted 20Apr09
The New Year Offerings, by Mick Raich, Vachette Pathology, posted 9Mar09
The Tangled Web of Claim Payments - How Managed Care Contracts Kill Your Revenue, by Mick Raich, Vachette Pathology, posted 4Nov08
Pathology takes another pay cut, by Mick Raich, Vachette Pathology, posted 24Oct08
Collaborative Labs and the Underlying Cost to Pathologists, by Mick Raich, Vachette Pathology, posted 3Sep08
Congress Delays Fee Schedule Cuts 6 Months - Or Not?, by John R. Outlaw, PSA, LLC, posted 1Apr08
Pathology Practice Management Issues for 2008, by Mick Raich, Vachette Pathology, posted 13Jan08
Pricing for Pathology Billing (part 2), by Mick Raich, Vachette Pathology, posted 19Apr07
Pricing for Pathology Billing (part 1), by Mick Raich, Vachette Pathology, posted 5Feb07
A Case Study in Increasing Practice Revenue through Managed Care Negotiations, by Mick Raich, Vachette Pathology, posted 24Jul06
Considerations for Outsourcing Billing Operations, by Pathology Service Associates, LLC, posted 31May06
Critical Strategies for Negotiating Contracts, by Mark S. Daniels, Audit Quality Inc., posted 4May06
Managed Care Payment Shopping, by Mick Raich, Vachette Pathology, posted 23Mar06
What Two Factors Are Critical to Maximizing Revenue?, by Mark S. Daniels and Ken Brodeur, Audit Quality Inc., posted 14Dec05
Are You Using Your Monthly Billing And Collection Reports Effectively by Al Sirmon, CPA, CEO, Pathology Service Associates, LLC, posted 3Nov04

Compliance
Five Simple Steps to Help You Avoid Audit Headaches, by Chappy Manning, PSA, LLC, posted 25 February 2011
The Case for Compliance: Why You Need an Effective Compliance Program, by John R. Outlaw, CHC, Chief Compliance Officer, PSA, posted 13Feb07

Direct billing / POD labs
Dèjà vu all Over Again, by Mick Raich, Vachette Pathology, posted 16 March 2011
CMS Continues to Tinker with Anti-Markup Rule, POD Labs and In-Office Histology Labs in the Cross-Hairs, by John Outlaw, PSA, LLC, posted 15Apr09
9.30.2005 - AP Day of Infamy, by Bernie Ness, B J Ness Consulting Group, LLC, posted 17Oct05
The Paradigm Shift in Pathology, by Bernie Ness, B J Ness Consulting Group, LLC, posted 10Mar05
To Bill or Not to Bill, That is The Question (Direct Billing), by Bernie Ness, B J Ness Consulting Group, LLC, posted 26Oct04


Other

Affordable Care Act (Obamacare)
Trump And Clinton On Health Care: The Status Quo Vs. An Undefined Vision, by Alex Mitchell, Vachette Pathology, posted 8 June 2016
The Health Insurance Marketplace and What The Health Exchange Plans Mean for Your Practice, by Ann Lambrix and Mick Raich, Vachette Practice Management / Stark Medical Auditing, posted 28 February 2014

Management - general
ACO's, Practice Buy-outs and Dèjà vu All over Again, by Mick Raich, Vachette Pathology, posted 9 July 2012
Hospital Outreach Laboratory For Sale. Who's Buying Now? by Mick Raich, Vachette Pathology, posted 30Nov08

Marketing
Strategies for Growing the Independent Pathology Practice, by Lisa A. Gryscavage, Vachette Pathology Services, posted 29Aug05
We Don't Need Any Sales Representation, Do We? by Bernie Ness, B J Ness Consulting Group, LLC, posted 13Dec04

Pathologist salaries
Pathology Salaries and the Big Picture, by Mick Raich, Vachette Pathology, posted 6 December 2010


Management Chapter - Anatomic Pathology Practices
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See also Computer Systems-AP/LIS

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