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vachettepathology.com Who's Watching Your Wallet? Vachette Monthly, June 2020 Dissecting the COVID-19 uninsured payment portal Column from Vachette CEO Mick Raich -- Several years ago, I wrote about how the big national health care companies may be an access point for the development of a national health service. Well, during the COVID crisis one of these companies, Optum and its parent company UnitedHealthcare (UHC), has stepped up to the challenge. They have built the Health and Human Services COVID-19 Uninsured Payment Portal, which allows providers to submit claims for uninsured COVID-19 patients. Providers must sign up for an Optum Identification number, and then fill out an attestation form stating they are submitting claims for only uninsured patients. The provider will then submit the claim to Optum and receive an individual patient identification number. Once this is received, they then can submit the claim. This takes, on average, three days. The provider will then be paid at 100% of the Medicare rate for the test. Several items must be noted. First, the money will run out over time unless the new stimulus package adds additional revenue. Second, claims can only be billed from patients after with dates of service after Feb. 4, claims could only be submitted as of May 6, and payment was expected to start as of May 18. There are a couple issues I expect we will see with this in the future. Many providers will try to submit claims for patients with co-pays or deductibles when in fact this is only for patients without any insurance. This will need to be audited as it is inevitable claims will slip through the cracks. Furthermore, we have seen several providers call us and want to submit claims to Optum from startup labs who do not even have billing software or billing companies. Getting audited by the OIG over this will be ugly and they will be watching these claims closely. The Billing Breakdown Welcome to The Billing Breakdown, a recurring column where we aim to highlight pathology and clinical lab billing issues that we encounter both in discussions with our clients and through our billing audits. These items are identified by Jennifer Martin, Vachette's Director of Special Audits. This month, we’re reviewing a commercial payer policy change regarding prostate biopsies. In a recent letter to providers, Cigna announced it will no longer reimburse prostate needle biopsies billed with CPT 88305 beginning Aug. 18. Instead, claims on or after that date must be submitted with HCPCS code G0416, one unit, to be eligible for payment. This move is being made to align Cigna with current CMS guidance, which stopped allowing multiple units of 88305 to be billed for prostate biopsies several years ago in an effort to curb spending on the procedure. View the letter here. Follow Vachette on Twitter, or visit our blog at vachettepathology.com for regular updates!
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Whos atching Your Wallet - vachettepathology.com

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Page 1: Whos atching Your Wallet - vachettepathology.com

vachettepathology.com

Who's Watching Your Wallet?

Vachette Monthly, June 2020

Dissecting the COVID-19 uninsured payment portalColumn from Vachette CEO Mick Raich -- Several years ago, I wrote about how the big national health care companies may be an access point for the development of a national health service. Well, during the COVID crisis one of these companies, Optum and its parent company UnitedHealthcare (UHC), has stepped up to the challenge. They have built the Health and Human Services COVID-19 Uninsured Payment Portal, which allows providers to submit claims for uninsured COVID-19 patients. Providers must sign up for an Optum Identification number, and then fill out an attestation form stating they are submitting claims for only uninsured patients.

The provider will then submit the claim to Optum and receive an individual patient identification number. Once this is received, they then can submit the claim. This takes, on average, three days. The provider will then be paid at 100% of the Medicare rate for the test.

Several items must be noted. First, the money will run out over time unless the new stimulus package adds additional revenue. Second, claims can only be billed from patients after with dates of service after Feb. 4, claims could only be submitted as of May 6, and payment was expected to start as of May 18.

There are a couple issues I expect we will see with this in the future. Many providers will try to submit claims for patients with co-pays or deductibles when in fact this is only for patients without any insurance. This will need to be audited as it is inevitable claims will slip through the cracks. Furthermore, we have seen several providers call us and want to submit claims to Optum from startup labs who do not even have billing software or billing companies. Getting audited by the OIG over this will be ugly and they will be watching these claims closely.

The Billing BreakdownWelcome to The Billing Breakdown, a recurring column where we aim to highlight pathology and clinical lab billing issues that we encounter both in discussions with our clients and through our billing audits. These items are identified by Jennifer Martin, Vachette's Director of Special Audits. This month, we’re reviewing a commercial payer policy change regarding prostate biopsies.

In a recent letter to providers, Cigna announced it will no longer reimburse prostate needle biopsies billed with CPT 88305 beginning Aug. 18.

Instead, claims on or after thatdate must be submitted withHCPCS code G0416, one unit, tobe eligible for payment.This move is being made to alignCigna with current CMSguidance, which stopped allowingmultiple units of 88305 to bebilled for prostate biopsies severalyears ago in an effort to curbspending on the procedure.

View the letter here.

Follow Vachette on Twitter, or visit our

blog at vachettepathology.com

for regular updates!

Page 2: Whos atching Your Wallet - vachettepathology.com

At Vachette, we specialize in consulting and auditing for labs and pathology practicesWe have been working with hospitals, laboratories, and hospital-based groups for more than 18 years. Visit vachettepathology.com, call 517-486-4262, or contact Dustin Suntheimer, vice president of sales and marketing, at 734-972-2693. Our experience and expertise are second to none!

Have you spoken with your biller about their protocol for ensuring

COVID-19 patients are not balanced billed?

If you haven't reviewed your

preliminary 2019 MIPS feedback yet,

now is the time to do so. Finalized scores are expected to be released

in July.

Miss our COVID-19 webinar? View the recording!We recently held our second informational COVID-19 revenue webinar to offer an update on our COVID revenue projections and review the status of various government relief funds and programs. If you missed the live event, the full recording recording is now available to view on our website. We're planning a follow-up event soon, so be sure to watch for an announcement and registration form.

UHC rolling back some COVID waiversHeads up for all UHC providers: As of June 1, all currently effective prior authorization requirements and site of service reviews are back in effect, according to a recently issued provider news bulletin. Additionally, claims with a date of service on or after Jan. 1, 2020 will not be denied for timely filing if submitted by June 30, 2020.

Florida Medicaid cuts several Clinical Pathology codes from fee schedule

Pathology groups and laboratories in Florida are now seeing the cuts in their reimbursement after Florida Medicaid cut several of the professional component (PC) rates out of their fee schedule for clinical pathology (CP).

For background, Florida is one of few states where Medicaid still pays for the PC of CP work. However, as of Jan. 1, many of the codes on the fee schedule that previously paid both the PC and technical component split now only include a rate for global payments. There are just a handful of codes that will still recognize both the technical and professional components separately.

Despite an extensive search of the Florida Medicaid website and even its archives we have not been able to find an actual communique on this change, despite confirming with our clients that it is now in effect.

Please see our spreadsheet online for a full breakdown of the affected codes.

TELCOR®

REVENUE CYCLE SOLUTIONSYou have options. If you manage your billing or choose to

outsource, TELCOR gives you options.

Our industry-leading, lab-specific software solution is rules-driven and robust enough for labs of any type or size.

Our billing service, TELCOR Revenue Cycle Services, gives labs unmatched access to their AR data for unlimited

control and transparency.

Both solutions offer real-time data analytics to successfully manage your business.

855-489-1207 • [email protected]©2019 TELCOR Inc. All rights reserved.

With TELCOR’s help, we were able to go in and reengineer our processes so we got paid more

quickly, got payments posted more efficiently, and just made everything much more automated than what is was previously.

~Nadra Conner, Pathology Laboratory Associates

Page 3: Whos atching Your Wallet - vachettepathology.com

Audit findings roundup• We recently recovered $250,000

for a client because their biller didn’t file claims in a timely manner and properly follow up on appeals! Who’s watching your wallet?

• We typically are looking for claims to be filed within 21 days of the DOS to allow for a healthy claims flow, get in front of timely filing and allow ample time for appeals. So imagine our surprise when 74% of the cases we reviewed in a recent audit were filed at least 30 days or more from the DOS!

• During a 200-case audit, we identified coding errors on 30 cases, a roughly 15% error rate!

Pathology Consultative Services

For over 25 years, providers have relied on Cleveland Clinic Laboratories for personalized and comprehensive pathology services.

Our expert staff provides primary diagnoses, subspecialty

consultations, and second opinion consults that form the

basis for effective patient care.

For more information, please visit clevelandcliniclabs.com.

UHC renegotiating legacy contracts in TexasIt appears another major payer is now seeking to rein in payments to pathologists and labs with long-standing “legacy” contracts as UHC recently began issuing letters to providers in Texas informing them of upcoming fee schedule cuts.

Last month, UHC began sending the letters to providers, which say in part that, “This new fee schedule is part of a larger effort to support community-based physicians. The commercial fee schedule reimbursement is based on 2019 CMS RVUs and geographically adjusted, and account for Site of Service differentials based on location of services performed, similar to CMS methodology.”

The letter goes on to state that anyone who does not agree to the new contract must notify UHC within 30 days of receipt of the notice. The exact amount of the cut depends on the provider’s existing contract. While we can’t disclose the exact numbers we’ve seen at this time, we can say those we have reviewed so far have been substantial.

While we have so far only been able to confirm providers in Texas have received these notices, the strategy being deployed seems to be similar to the effort Anthem took in 2019 to drastically reduce pathology and lab compensation in the payer’s markets across the nation.

We’re currently discussing strategic options for those looking to push back against these cuts. As always, if you are concerned about these reductions, a good first step is to reach out to your state pathology societies to coordinate a response.

In the meantime, if you have questions about these drastic rate adjustments, don’t hesitate to reach out to us at 517-486-4262 for a free consultation. VIEW THE FULL PROVIDER LETTER ONLINE HERE

Page 4: Whos atching Your Wallet - vachettepathology.com

Pathology & Laboratory

Billing Experts

• Privately-owned & operated

• National Presence

• Personalized Service

800.288.8325

www.apsmedbill.com

Rates for coronavirus serological tests established by CMS

On May 19, CMS released the long awaited payment rates for two commercial coronavirus serological testing codes published last month by the American Medical Association. Serological testing looks for antibodies against SARS-CoV-2, but not the virus itself.

The agency announced it would pay $42.13 for the multi-step method (86769) and $45.23 for the single-step method (86328).

• 86328 ($45.23) — Severe acute respiratory syndromecoronavirus (SARS-CoV-2) Coronavirus disease(COVID-19), single-step immunoassay. For antibodytesting using the multi-step method, use 86769.

• 86769 ($42.13) — Antibody; Severe acute respiratorysyndrome coronavirus (SARS-CoV-2) Coronavirus disease(COVID-19). For detection of antibodies other than thoseto infectious agents, see specific antibody or specificmethod.

Some billers charging to process HHS relief fundsDid you know some billers are charging a fee for processing the lump sum HHS Provider Relief funds? This money was given to practices last month, equal to roughly one month of their Medicare payments. This was given to all providers to help cover the cost of lost revenue due to COVID. Now they are being charged their billing fee on this? This is a time of financial struggle for many laboratories and pathology practices and it’s unconscionable to see firms charging for these funds. It is flat out price gouging.

We have found several billers who are charging for “processing” this lump sum to our laboratories or practices. There is no direct billing involved in these funds, and therefore, no direct cost to the billers. Here is what you need to do to prevent paying extra for this:

• Review your invoice to see if there are special notices on charges for this deposit.• Compare your billing collections and the actual amount deposited by your biller. If they do not match,

then you may have issues.• Call us with questions!

It amazes us to see this taking place. In this time of struggle, Vachette has lowered our fee to all our clients as they struggle to recover. To see these companies pad their invoices at this time is completely unscrupulous.

Review your invoice and call us with questions. We can help you solve this problem, ensure your revenue is correct going forward and if need be, find you a new biller with a modicum of ethical behavior.